A 24-year-old woman with Wilson's disease is started on D-penicillamine. After three weeks, she develops fever, arthralgia, and 3.5 g/day proteinuria. Urinalysis shows no casts. Serum creatinine is normal. What is the most appropriate next step in management?
- A Stop D-penicillamine and switch to trientine ✓
- B Continue D-penicillamine and add an ACE inhibitor
- C Stop D-penicillamine and switch to oral zinc sulfate
- D Add prednisone and continue D-penicillamine
Correct answer: A. Stop D-penicillamine and switch to trientine
Explanation
D-penicillamine can cause nephrotic syndrome and drug-induced lupus. Significant proteinuria is an indication to discontinue D-penicillamine. Trientine is a chelating agent used as an alternative in patients intolerant to D-penicillamine. Zinc is used for maintenance or presymptomatic patients but is not first-line for acute chelation in a symptomatic patient who needs ongoing decoppering therapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.