Take the lead |
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| Institution: | 1. Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands;2. Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands;3. Department of Human Genetics, Section Ophthalmogenetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands;4. Queen Emma Center of Precision Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands;5. Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands;6. Diagnostic Center for Complex Visual Disorders, Zeist, the Netherlands;1. Rome Eye Hospital, Rome, Italy;2. Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Public Health Department, University of Naples Federico II, Naples, Italy;3. UOC Ophthalmology and Surgery Department, ASL-1 Avezzano-Sulmona, L''Aquila, Italy;4. Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy;5. IRCCS-Fondazione Bietti, Rome, Italy;6. Department of Biomedical and Clinical Science “Luigi Sacco”, Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy;7. Department of Medicine-Ophthalmology, University of Udine, Udine, Italy;8. University Eye Clinic, IRCCS Multimedica, Milan, Italy;9. Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy;10. Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;11. Catholic University “Sacro Cuore”, Rome, Italy;1. International School of Public Health and One Health, Hainan Medical University, Haikou, China;2. Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun -Yat-sen University, Haikou, China |
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| Abstract: | A 23-year-old previously healthy woman presented with headache, generalized seizures, ataxia, encephalopathy, abdominal pain, nausea, and vomiting culminating in a 40-pound weight loss. A contrasted magnetic resonance imaging scan of the brain showed T2/FLAIR hyperintensities in the sulci of the occipital and parietal lobes, a punctate focus of restricted diffusion along the inferior aspect of the left caudate head and an empty sella. A lumbar puncture showed an opening pressure of 55 cm H2O, and kidney, ureter, and bladder X ray showed a radiopaque particle in the colon. Serum lead level was 85 mcg/dL (< 3.5). Blood smear showed foreign bodies identified as lead particles in the blood with basophilic stippling of RBCs. She was treated with chelation therapy and bowel irrigation and eventually recovered. Further investigation indicated that she was being slowly poisoned by her husband, a chiropractor who had access to lead. |
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| Keywords: | Plumbism Lead toxicity Papilledema Encephalopathy |
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