Images in Clinical Medicine
Getting the Lead Out
N Engl J Med 2004; 351:1996November 4, 2004
- Article
A 32-year-old man reported having had back and abdominal pain, nausea, and constipation for several weeks. The results of laboratory studies were notable for normocytic anemia, a hemoglobin level of 7.9 g per deciliter, a mean corpuscular volume of 82 μm3, and basophilic stippling of erythrocytes. The serum lead level was elevated, at 143.5 μg per deciliter (6.9 μmol per liter; normal, less than 10.0 μg per deciliter [0.5 μmol per liter]). The man had sustained a gunshot wound to the right elbow six years earlier. The radiograph of the elbow showed the presence of multiple radiodense opacities. The joint space was opened, and fragments of the bullet were seen to be invading the synovium. Treatment with EDTA and dimercaprol was initiated immediately. The lead level decreased to 30 μg per deciliter (1.4 μmol per liter), and the patient's symptoms resolved. He was lost to follow-up but presented again five months later with recrudescent symptoms and a serum lead level of 116 μg per deciliter (5.6 μmol per liter). His symptoms again resolved with chelation therapy. Treatment with succimer and surgical exploration were recommended on an outpatient basis. The patient was lost again to follow-up.
Joy Shen, M.D.
Robert Hirschtick, M.D.
Northwestern University, Feinberg School of Medicine, Chicago, IL 60611- Citing Articles (2)
Citing Articles
1
Liwei Mi, Hongwei Hou, Zhiyong Song, Huayun Han, Yaoting Fan. (2008) Polymeric Zinc Ferrocenyl Sulfonate as a Molecular Aspirator for the Removal of Toxic Metal Ions. Chemistry - A European Journal 14:6, 1814-1821
CrossRef2
Harris, Paul, . (2005) Getting the Lead Out. New England Journal of Medicine 352:8, 841-843
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