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Lead Poisoning presenting as acute severe myalgia: Why was the diagnosis delayed and what lessons can we learn as
T Petterson1, Jm McLaren, Dcr McGouran
1Hutt Valley District Health Board, Hutt Hospital, High Street, Lower Hutt, Private Bag 31-907 Lower Hutt, 5040 New Zealand;
Abstract:
Patients presenting to the "front door" with acute neuromuscular symptoms are challenging. Toxins need consideration as possible causative agents if there is the possibility of relevant exposure. This requires a thorough history1 and an awareness of local ethnic, social and industrial cultures within the practice locality. We describe a case of lead poisoning in a 35 year old man who presented with severe, progressive, myalgia. We consider that basic errors in clinical processing delayed a potentially difficult and serious diagnosis and these are discussed. The importance of maintaining a thorough initial clerking process within the Acute Medical Unit is highlighted. This should include a comprehensive occupational history. Acute physicians should familiarize themselves with local industry and the toxic syndromes they can produce.
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