Manganese deposition in the brain following parenteral manganese administration in association with radical operation for esophageal cencer: Report of a case

We report herein the case of a patient in whom manganese (Mn) deposition in the basal ganglia was detected by magnetic resonance imaging (MRI) subsequ ent to thoracic esophagectomy, performed following perioperative parenteral nutrition. A multi-trace-element supplement solution which included 20 mu mol of Mn per day had been parenterally administered for 7 days preoperativ ely and 21 days postoperatively. The serum level of total bilirubin reached a maximum value of 5.1mg/dl postoperatively. The T1-weighted MRI on the 32 nd postoperative day demonstrated bilateral and symmetrical hyperintense le sions in the globus pallidus and the whole-blood Mn level on the 34th posto perative day was 4.9 mu g/l, the normal range being 0.8-2.5 mu g/l. This hy perintensity on T1-weighted MRI was gradually improved following normalizat ion of the blood Mn level. This case report serves to demonstrate that even short-term perioperative parenteral nutrition may result in Mn deposition in the brain following radical surgery for esophageal cancer, especially in patients with hyperbilirubinemia.