Abstract
A 24-year-old woman, an administrative employee, was admitted with colicky abdominal pain and constipation, as well as breathing-related chest pain of recent onset with cough and sometimes blood-streaked sputum. She had previously been unsuccessfully treated for gastritis and adnexitis. On physical examination revealed diffuse, ill-defined abdominal pain on pressure and mild tachycardia, but was otherwise unremarkable. Electrocardiogram, chest radiogram, lung scintigraphy, abdominal sonography, oesophago-gastro-duodenoscopy and gynaecological examination indicated nothing abnormal. Laboratory tests showed microcytic anemia, slight leucocytosis and anisocytosis, as well as polychromasia and basophilic stippling of erythrocytes. The 24-h urinary porphyrin concentration was elevated. DIAGNOSIS TREATMENT AND COURSE: Precise differentiation of porphyrins in urine, stool and erythrocytes by enzymatic measurement first raised the suspicion of lead poisoning. Whole-blood lead concentration was markedly raised to 600 micrograms/l (normal up to 90 micrograms/l) and 170 micrograms/dl in urine (normal up to 80 micrograms/dl). A ceramic cup from Greece was traced as the source of the lead, the patients having regularly for over 2 1/2 months drunk lemon instant-tea from it. She was treated with oral doses of DMPS (sodium salt of 2,3-dimercapto-1-propanesulphonic acid), 5-10 mg/kg 3x daily for 2 days, followed by 2.5 mg/kg 2 x daily, until lead concentrations in blood and urine had become normal, when all symptoms disappeared: detoxification was complete within 4 months. This case impressively illustrates how difficult it can be to diagnose lead poisoning and identify its source. Oral DMPS is a practicable and efficacious form of treatment.
Published Version
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