Case 78: Small Fiber Neuropathy in Wilson Disease

Abstract

The tilt test provoked characteristic syncope, mixed form, with simultaneous decline in heart rate and blood pressure. Small fiber neuropathy, severe, length-dependent, mixed, affecting both sensory and autonomic fiber was diagnosed. This patient had several potential causes of small fiber neuropathy, including metabolic derangement after bariatric surgery, Wilson disease, and chronic therapy with penicillamine.