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Systemic Lead Poisoning Secondary to Retained Intra-articular Bullet: A Case Report
Damon Dunwody1, Jack Lambert1, Andrew Register1
1Georgia Orthopedic Trauma Institute, Mercer University School of Medicine, Macon, Georgia.
JBJS Case Connector
|July 30, 2026
Summary
A retained bullet fragment caused severe lead poisoning 27 years after injury. Early recognition and combined medical/surgical treatment resolved neurological symptoms and lowered blood lead levels.
Area of Science:
- Orthopedics
- Toxicology
- Neurology
Background:
- Retained bullet fragments can lead to chronic health issues.
- Lead synovitis is a rare complication of intra-articular bullet fragments.
- Delayed diagnosis of lead poisoning can result in severe neurological deficits.
Purpose of the Study:
- To report a case of delayed lead poisoning from a retained intra-articular bullet.
- To emphasize the importance of considering retained bullet fragments in differential diagnosis.
- To highlight the necessity of prompt medical and surgical intervention.
Main Methods:
- A 49-year-old male presented with confusion, hallucinations, and seizures.
- Imaging revealed lead synovitis secondary to a bullet fragment from a 27-year-old gunshot wound.
- Blood lead levels were critically elevated, prompting chelation therapy and surgical removal of the bullet fragment and affected synovial tissue.
Main Results:
- The patient's neurological symptoms resolved after treatment.
- Blood lead levels significantly decreased post-chelation and surgery.
- Histopathology confirmed metal staining of the synovial tissue.
Conclusions:
- Intra-articular bullet fragments can cause severe lead poisoning years after the initial injury.
- Early recognition of lead poisoning from retained bullets is crucial.
- Combined chelation therapy and surgical management are effective treatments.