BMJ Case Reports 2018; doi:10.1136/bcr-2017-222388
  • Reminder of important clinical lesson

Lead in a case of encephalopathy

  1. Avanish Tantry1
  1. 1Department of Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Department of Specialist Laboratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Amy Talbot, amytalbot{at}
  • Accepted 16 February 2018
  • Published 9 March 2018


A 2-year-old boy with a history of pica was admitted with vomiting and treated overnight for viral tonsillitis. A week later, he presented with a prolonged afebrile seizure and required intubation and ventilation. Antibiotics and acyclovir were started. Despite extensive investigations including MRI head, no cause was identified. Four days later, he deteriorated with signs of raised intracranial pressure. On day 5, blood lead concentration in the sample collected at admission was reported as grossly elevated, consistent with a diagnosis of severe lead poisoning from ingesting lead-containing paint at the family home. Chelation therapy was started but, unfortunately, he did not make a neurological recovery, and care was withdrawn. A serious case review identified a lack of awareness of lead poisoning and its relation to pica as a root cause. We report this case to share our experience and the importance of considering lead poisoning in children with pica.


  • Contributors All authors have contributed to the writing of this report. ALT wrote the summary, case and organised the final formatting of the report. CL wrote the discussion. AT collected the date in the tables. All authors met regularly and were involved in the editing of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

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

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