# Generalized Dystonia in a Patient With Wilson Disease 5 Years After Liver Transplant: A Case Report

## TL;DR

A man with Wilson disease developed generalized dystonia five years after a liver transplant, and his symptoms improved with botulinum toxin injections.

## Contribution

This case report highlights generalized dystonia as a rare post-transplant complication in Wilson disease.

## Key findings

- A 29-year-old man with Wilson disease developed generalized dystonia five years after liver transplant.
- Symptoms improved with botulinum toxin injections despite normal MRI and copper studies.
- Post-transplant neurologic complications may stem from copper dysregulation or immunosuppressant effects.

## Abstract

Liver transplant (LT) is considered curative for Wilson disease (WD) with hepatic failure refractory to medical therapy, particularly when neurologic symptoms are absent.

A 29-year-old man with WD developed progressive generalized dystonia five years after LT. He presented with acute-on-chronic neck pain, dysphagia, and dystonic posturing of the neck, trunk, and upper and lower extremities. MRI brain and copper studies were normal. Genetic testing confirmed two heterozygous pathogenic ATP7B variants. Symptoms improved with botulinum toxin injections.

Post-LT neurologic complications may arise from copper dysregulation, immunosuppressant neurotoxicity, or unrelated primary dystonia. Early recognition enables effective symptomatic management.