Lead poisoning by intradiscal firearm bullet: a case report

Area of Science:

• Medical Case Reports
• Toxicology
• Orthopedic Surgery

Background:

• Lead poisoning from firearm projectiles is uncommon.
• Bullets lodged in joints warrant investigation for lead toxicity.
• Intradiscal bullet retention poses unique diagnostic challenges.

Observation:

• A 30-year-old man presented with symptoms of lead poisoning 5 years after an intradiscal gunshot wound.
• Clinical presentation included severe lumbar pain, colic, constipation, insomnia, and headache.
• Radiological imaging confirmed bullet location within the L2-L3 intervertebral disc.

Findings:

• Laboratory results confirmed lead poisoning.
• Treatment involved chelation therapy with calcium versenate (disodium ethylenediaminetetraacetate, or CaNa(2)EDTA).
• Surgical removal of the bullet was performed, followed by a second chelation cycle due to recurrence, leading to complete resolution.

Implications:

• This case highlights the potential for delayed lead poisoning from retained firearm bullets.
• Effective management requires a combination of chelation therapy and surgical intervention.
• Early diagnosis and treatment are crucial for resolving severe clinical manifestations of lead toxicity.