doiSerbia

Acute lead intoxication: A rare cause of abdominal pain

Alempijević Tamara (Klinika za gastroenterohepatologiju, Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Đuranović Srđan (Klinika za gastroenterohepatologiju, Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)
Bogdanović Andrija (Institut za hematologiju, Klinički centar Srbije, Beograd)
Kovačević Nada (Klinika za gastroenterohepatologiju, Institut za bolesti digestivnog sistema, Klinički centar Srbije, Beograd)

Abdominal pain is a common symptom of various diseases and conditions of different aetiology. The aim of the interpretation of abdominal pain is to reach an early and accurate diagnosis, thereby enabling appropriate treatment. Acute abdominal pain may be the result of a number of abdominal, as well as extra-abdominal causes, lead poisoning being one such extraabdominal cause. Here, we report the case of a 73-year-old male patient, admitted for clinical investigation of a suspected tumour of the colon, due to the presence of acute convulsive abdominal pain, without propagation, constipation, and anaemia. A history provided by the patient’s family indicated his exposure to lead. The absence of any abdominal pathology, increased levels of lead in the blood (5.249 μmol/l), the presence of basophilically punctuated red blood cells, as well as a ring of sideroblasts, all indicated that the patient’s symptoms (abdominal pain, constipation, and anaemia) were the result of acute lead intoxication. The patient’s case history, including lead exposure, the absence of pathological findings via endoscopic and x-ray examination, laboratory findings (normocytic anaemia, an increased serum lead concentration, basophilically punctuated red blood cells, and the presence of an abundant ring of sideroblasts), all indicated that his symptoms were the result of lead intoxication. After six months of chelation therapy (EDTA), his symptoms completely disappeared, and his laboratory findings returned to normal. This presentation aims to underscore the importance of meticulous history taking, as well as of the selection of suitable laboratory and other auxiliary diagnostic methods in the correct diagnosis of this rare condition.

Keywords: lead intoxication, abdominal pain, anaemia, constipation