# A Rare Case of Brain Manifestation of Manganese Toxicity and Its Management: A Case Report and Literature Review

## TL;DR

A rare case of manganese toxicity in a child with chronic liver disease is reported, highlighting the importance of early diagnosis and treatment.

## Contribution

This case report presents a rare instance of brain manganese toxicity in a child with chronic liver disease and demonstrates successful chelation therapy.

## Key findings

- Manganese toxicity can manifest with neurological symptoms in children with chronic liver disease.
- Chelating therapy successfully reduced manganese deposition in the brain.
- Early recognition and interdisciplinary management are crucial for treating manganese toxicity.

## Abstract

Manganese (Mn) toxicity is a rare but perplexing condition, often difficult to diagnose due to its unusual clinical presentation. Mn toxicity's neurological symptoms can be nonspecific, making early diagnosis crucial. The unique association between chronic liver disease and Mn toxicity highlights the need for increased clinical awareness and further research. We present a case of a five-year-old Asian male child with chronic liver disease who presented with neurological symptoms due to brain Mn deposition and its management. Notably, Mn exhibits a propensity for preferential accumulation in the basal ganglia, specifically targeting dopamine-producing (DAergic) neurons. The child's response to interventions, including a reduction in Mn deposition in the brain using chelating therapy, underscores the significance of early recognition and comprehensive management in addressing this condition. This case report delves into an exceptional instance of Mn toxicity, emphasizing the significance of early recognition and interdisciplinary intervention.