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Lead poisoning after gunshot wound
P R de Madureira1, E M De Capitani, R J Vieira
1Intoxication Control Center, Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, Brazil.
Summary
Lead bullet fragments lodged in joints can cause lead intoxication, even years later. Surgical removal of fragments may be necessary for chronic cases.
Area of Science:
- Orthopedic Surgery
- Toxicology
Background:
- Lead bullet fragments retained in joints may lead to chronic lead exposure.
- Awareness of potential lead intoxication symptoms is crucial for patients with retained bullet fragments, particularly in large joints.
Observation:
- A 23-year-old male with a history of alcohol abuse presented with recurrent gastrointestinal symptoms including abdominal pain, vomiting, and diarrhea.
- Radiography revealed a bullet lodged in the left hip with synovial capsule involvement.
Findings:
- The patient developed clinical lead intoxication years after a gunshot wound.
- Initial chelation therapy with calcium versenate (EDTACaNa2) was ineffective in resolving symptoms.
- Surgical intervention, specifically hip arthroplasty, was ultimately required to address the chronic lead mobilization.
Implications:
- This case highlights the delayed presentation of lead intoxication from retained bullet fragments.
- Prompt diagnosis and consideration of surgical fragment removal are vital for managing chronic lead exposure from intra-articular bullets.
- Joint replacement surgery can be a definitive treatment for lead intoxication caused by intra-articular bullet fragments.