Objective: To describe a patient with idiopathic zinc overload without an identifiable source and secondary copper deficiency causing myelopolyneuropathy and pancytopenia. Design: Case report. Patient and Results: A 46-year-old man presented with severe bone marrow suppression and subsequently developed progressive myelopathy with sensory ataxia. No identifiable cause of myelopathy was detected, and his neuroimaging findings were unremarkable. Plasma analysis demonstrated a low copper level and

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... an increased zinc level (Ͻ10 µg/dL [Ͻ12.6-18.9 µmol/L] and 184 µg/dL [28.2 µmol/L], respectively; normal range for both, 80-120 µg/dL [12.6-18.9 µmol/L and 12.3-18.4 µmol/L, respectively) and a low level of ceruloplasmin. There was no evidence for an external source of zinc. Daily oral supplementation with 2 mg resulted in the prompt reversal of hematologic abnormalities, improved but still subnormal plasma copper