Review for 10.1186/s12876-021-01859-6 (2021)

Reviewer’s report
Title: 
Exogenous Copper Exposure Causing Clinical Wilson Disease in a Patient
with Copper Deficiency
Version: 
1 
Date: 
25 Feb 2021
Reviewer's report:
The case described is very interesting. I personally cannot understand how the
patient initially developed the copper deficiency. What basal condition did he
have to justify his initial copper deficiency? Molecular analysis for Wilson
disease (WD) was negative, but did the patient initially receive a diagnosis of
WD? I suppose not because the patient was not treated for WD (chelators or zinc
therapy) and received copper supplementation. What 
was the basal cupruria
value? How many occasions has basal cupruria been tested? Unfortunately, there
is a small subgroup of Wilsonian patients with negative molecular analysis. In
addition to cupruria, the quantitative determination of hepatic copper would have
been useful to accurately exclude WD. Initial myelopathy was not confirmed on
MRI. Was he monitored during copper supplementation? with what timing? is it
possible to know the trend of 24-hour cupruria over time? Why has copper
overload not been diagnosed before?
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