Case Report Zinc Monotherapy as an Alternative Treatment Option for Decompensated Liver Disease due to Wilson Disease? Hansa Haftu , 1 Mohammed Mustefa, 1 and Teklu Gebrehiwot 2 1 Mekelle University, College of Health Science, Pediatric and Child Health Department, Tigray, Ethiopia 2 Mekelle University, College of Health Science, Clinical Pharmacist, Tigray, Ethiopia Correspondence should be addressed to Hansa Haftu; hansahaftu21@gmail.com Received 16 October 2019; Revised 3 December 2019; Accepted 21 December 2019; Published 14 January 2020 Academic Editor: Melanie Deutsch Copyright © 2020 Hansa Haftu et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Wilson disease is a rare metabolic disorder involving copper metabolism, and patients may present with a variable degree of hepatic, neurologic, and psychiatric manifestations. In the case of hepatic presentation, treatment is usually initiated with potentially toxic copper chelators (D-penicillamine or Trenton). Although zinc is of low toxicity and low cost for treatment of Wilson disease, it has been limited to the adjunctive as a single maintenance drug or for asymptomatic patients. e use of zinc monotherapy in patients suffering from a severe liver disease was not well studied. In our case report, we describe a pediatric patient who presented with liver failure and the use of zinc monotherapy in patients with severe hepatic manifestations. Case presentation. A 15-year-old male patient from Ethiopia presented with generalized body swelling (edema and ascites) with yellowish discoloration of his eyes and easy fatigability. He had hyperbilirubinemia, coagulopathy, hypoalbuminemia, and deranged liver enzymes. He had a Keyser–Fleischer ring visible with the naked eye, which was confirmed by slit-lamp exam- ination. He had very low serum ceruloplasmin (<8 mg/L) and high 24-hour urine copper (150 mcg/dl). In accordance with the scoring system proposed by the 8th International Meeting on Wilson Disease and Menkes Disease, a diagnosis of Wilson disease was made. Zinc monotherapy with low copper diet was initiated for decompensated liver disease due to Wilson disease because of the inaccessibility of chelators (D-penicillamine or Trientine). After months of treatment with zinc, the patient experienced normalization of hepatic synthetic function and resolution of hypoalbuminemia and coagulopathy. e patient had also clinically stabilized (ascites, lower extremity swelling, edema, and jaundice were improved. Currently, the patient is on follow-up almost for the last four years in the gastrointestinal clinic. Conclusion. Our case shows that zinc has the potential for treatment in improving liver function. ough zinc has its own side effects, it is important and maybe an alternative treatment option in those with limited resources (not able to access chelators). is example hopefully will encourage future investigations and researches on zinc monotherapy for treating symptomatic decompensated hepatic Wilson disease. 1.Background Wilson disease (WD) is a rare autosomal recessive genetic disorder of copper metabolism, which is a defective biliary excretion of copper, resulting in the accumulation of copper in the liver, brain, kidney, and cornea. e disease affects one in 100,000 individuals [1, 2]. Patients with WD have varying clinical presentations ranging from an asymptomatic state to acute life-threatening liver involvement (acute liver failure), which can cause high mortality reaching 95% without liver transplantation [1, 3, 4]. Other patients may present with chronic liver disease mimicking other etiologies and neuropsychiatric manifestations. ough acute liver failure (ALF) presentation is rare in pediatric age groups (only 3% of all ALF case series in children), it is dramatic and may result in suddenness [3]. Although Wilson disease is rarely diagnosed and reported in African children, it must be considered differential in any patient with liver disease. ere are few reports regarding zinc monotherapy in pa- tients with decompensated liver disease. Our case report documents the role of zinc monotherapy in clinical reso- lution and normalization of laboratory liver synthetic dys- function in patients with the severe hepatic presentation of Wilson disease. Hindawi Case Reports in Hepatology Volume 2020, Article ID 1275940, 5 pages https://doi.org/10.1155/2020/1275940