Isolated Proximal Muscle Myopathy and Generalized Fatigability Associated with Severe Zinc Deficiency Following Sleeve Gastrectomy: A Case Report

Zinc is a vital micronutrient that plays a role in many bodily functions, such as controlling the immune system, making proteins, and breaking down cells.Zinc deficiency is commonly acknowledged in postbariatric patients; however, its manifestation as isolated myopathy without typical dermatological signs is rare and may impede timely diagnosis.We report the case of a 49-year-old woman who presented with a five-month history of progressive generalized fatigue and proximal muscle weakness, resulting in a significant impairment of her activities of daily living.Her past medical history was significant for laparoscopic sleeve gastrectomy five years ago with reported compliance with routine multivitamin supplementation.On clinical examination, the muscle strength was decreased (4/5) without sensory deficits or cutaneous abnormalities.The initial laboratory work-up, including hematologic, metabolic, endocrine, and autoimmune studies, was essentially unremarkable except for an elevated erythrocyte sedimentation rate.Further work-up for trace elements revealed a significantly low serum zinc level with other minerals within normal limits.A diagnosis of myopathy due to severe zinc deficiency was made.The patient received oral zinc supplementation, resulting in complete clinical recovery and normalization of zinc levels within four months.This case demonstrates a unique manifestation of zinc deficiency presenting as isolated proximal myopathy in a post-sleeve gastrectomy patient, years after surgery and without classical features.It stresses the importance of evaluating trace element deficiencies in the differential diagnosis of unexplained neuromuscular symptoms and supports the need for long-term nutritional monitoring after bariatric procedures.