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CASE REPORT
Severe lead toxicity attributed to bullet fragments retained in soft tissue
  1. Debora Weiss1,2,
  2. Don Lee3,
  3. Ryan Feldman4,
  4. Kate E Smith5
    1. 1Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA
    2. 2Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, Madison, Wisconsin, USA
    3. 3Ascension Columbia St. Mary's, Milwaukee, Wisconsin, USA
    4. 4Wisconsin Poison Center, Childrens Hospital of Wisconsin, Froedert & the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
    5. 5University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Trace Element Research Laboratory, Madison, Wisconsin, USA
    1. Correspondence to Dr Debora Weiss, woy2{at}cdc.gov

    Summary

    A man aged 30 years presented to an emergency department with a 1 month history of severe abdominal pain, jaundice, constipation, lower extremity weakness and weight loss. A peripheral blood smear was performed that showed basophilic stippling of erythrocytes prompting a blood lead level (BLL) evaluation. The patient had a BLL of >200 µg/dL. Retained bullet fragments were identified in the left lower extremity from a previous gunshot wound 10 years prior. Lead from the excised bullet fragment was consistent with the patient's blood lead by isotope ratio analysis. This case is a rare example of a severely elevated BLL attributed to bullet fragments in soft tissue. Bullets retained in soft tissue are not often considered a risk factor for a markedly elevated BLL because they become encapsulated within the tissue over time.

    https://doi.org/10.1136/bcr-2016-217351

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      Footnotes

      • Collaborators Carrie D Tomasallo, Jon G Meiman, Martin M Shafer and Henry A Anderson.

      • Competing interests None declared.

      • Patient consent Obtained.

      • Provenance and peer review Not commissioned; externally peer reviewed.