Lead intoxication and knee osteoarthritis after a gunshot: long-term follow-up case report

Gameiro, Vinícius Schott; Araújo, Gabriel Costa Serrão de; Bruno, Felipe

doi:10.1136/bcr-2013-009404

Cited by 6 publications

(4 citation statements)

References 14 publications

(11 reference statements)

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“…1 6 Lead arthropathy, caused by RBF lodged inside a joint, is suspected to result from biomechanical forces and permanent contact with synovial fluid (rich in hyaluronic acid) expose to greater risk of lead dissolution, inflammation and diffusion to adjacent tissues and the bloodstream. [7][8][9][10] The diagnosis of systemic lead poisoning is complex since the clinical presentation can be very rich, nonspecific, given many possible systemic effects. General signs may include asthenia, malaise, neurological, gastrointestinal, rheumatological or renal signs.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory low back pain with radiculopathy revealing epidural disintegration of a bullet complicated by lead poisoning

Do,

Garzelli,

Garnier

et al. 2023

RMD Open

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Inflammatory low back pain with radiculopathy is suggestive of cancer, infection or inflammatory diseases. We report a unique case of a 42-year-old patient with an acute inflammatory low back pain with bilateral radiculopathy associated with weight loss and abdominal pain, revealing the disintegration of a lead bullet along the epidural space and the S1 nerve root complicated by lead poisoning. Because of the high blood lead level of intoxication (>10 times over the usual lead levels) and the failure of repeated lead chelator cycles, a surgical treatment to remove bullet fragments was performed. It resulted in a significant decrease of pain and lead intoxication.

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Section: Discussionmentioning

confidence: 99%

Inflammatory low back pain with radiculopathy revealing epidural disintegration of a bullet complicated by lead poisoning

Do,

Garzelli,

Garnier

et al. 2023

RMD Open

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“…However, there are exceptions to this rule [8]. Missiles close to the bone, [17], joints, and intervertebral disks are continuously bathed with synovial fluid, which eventually washes off lead from the bullets resulting in systemic toxicity [18,19]. Females are more vulnerable to this form of toxicity which can then lead to neuropathy [16,20].…”

Section: Discussionmentioning

confidence: 99%

A Potentially Dangerous Industrial Projectile Lodged in the Leg of a Steel Factory Worker

Khurana

Jain

Gupta

et al. 2021

Cureus

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Penetrating injuries due to fragments energized by an explosive event are life/limb-threatening and are associated with poor clinical and functional outcomes. Penetrating injuries are commonly inflicted in attacks with explosive devices. The extremities, especially the leg, are the most commonly affected body areas, presenting a high risk of infection, slow recovery, and the threat of amputation. This report presents a case of a young factory worker who sustained an injury to the leg with a foreign body lodged near the neurovascular bundle.A 44-year-old gentleman sustained a projectile injury while working in a stainless steel factory from the rula (steel rolling) machine with a foreign body getting lodged in the leg in March 2019. He was initially managed with wound care and didn't report any functional impairment. Gradually patient developed numbness and claudication symptoms of the foot over the next couple of years. He was subsequently operated on in 2021 for removal of the stainless steel foreign body encased in dystrophic calcification close to the tibial nerve and posterior tibial vessels. Interestingly the entry point of the foreign body was on the anterolateral aspect of the leg. The foreign body was removed using the postero-lateral approach to the tibia with careful dissection close to the neurovascular bundle. At a follow-up of 3 months, the patient is symptom-free with significant improvement of limb function.The authors propose that the foreign body crossed the interosseous membrane to get lodged close to the posterior tibial neurovascular bundle. In such a scenario, the patient was extremely lucky to have survived an amputation or significant functional injury of the limb. Proper protective equipment is needed not only for the torso but also for extremities to protect industrial workers from such limb-threatening injuries. Moreover, primary care physicians should be sensitised for the proper management of such injuries.

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“…It is thought that initial impact with bone, fragments the missile with subsequent release [7]. Missiles lodged in or close to joints and intervertebral disks are continuously bathed with synovial fluid, which eventually washes off Pb from the bullets resulting in systemic toxicity [51–55]. Females are especially vulnerable to this form of toxicity [56].…”

Section: Discussionmentioning

confidence: 99%

Examination of metal mobilization from a gunshot by scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy: a case report

et al. 2018

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BackgroundProjectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. However, the local effect around the metallic object has not been investigated and the main goal of our study is to examine the influence of the object in close proximity of the object.Case presentationA 36-year-old Caucasian woman with one metallic pellet close to her sciatic nerve due to a previous shotgun injury at the gluteal area presented with a diagnosis of recurrent lumbar disk herniation at L4–5 level. A physical examination confirmed chronic neuropathy and she underwent a two-stage surgery. The surgery included removal of the foreign body, followed by discectomy and fusion at the involved level. During the removal of the metallic foreign body, a tissue sample around the pellet and another tissue sample from a remote area were obtained. The samples were analyzed by scanning acoustic microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Lead, chromium, copper, cadmium, iron, manganese, selenium, and zinc elements in tissue, blood, and serum specimens were detected by inductively coupled plasma optical emission spectroscopy.ConclusionsAn acoustic impedance map of the tissue closer to the metallic body showed higher values indicating further accumulation of elements. Energy-dispersive X-ray spectroscopy results confirmed scanning acoustic microscopy results by measuring a higher concentration of elements closer to the metallic body. Scanning electron microscopy images showed that original structure was not disturbed far away; however, deformation of the structure existed in the tissue closer to the foreign body. Element analysis showed that element levels within blood and serum were more or less within acceptable ranges; on the other hand, element levels within the tissues showed pronounced differences indicating primarily lead intoxication in the proximity of the metallic body. We can state that residues of metallic foreign bodies of gunshot injuries cause chronic metal infiltration to the surrounding tissue and induce significant damage to nearby neural elements; this is supported by the results of scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy.

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Lead intoxication and knee osteoarthritis after a gunshot: long-term follow-up case report

Cited by 6 publications

References 14 publications

Inflammatory low back pain with radiculopathy revealing epidural disintegration of a bullet complicated by lead poisoning

Inflammatory low back pain with radiculopathy revealing epidural disintegration of a bullet complicated by lead poisoning

A Potentially Dangerous Industrial Projectile Lodged in the Leg of a Steel Factory Worker

Examination of metal mobilization from a gunshot by scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy: a case report

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