Lead Poisoning by Intradiscal Firearm Bullet

Abstract

Lead poisoning can result in severe clinical disorders that require rapid treatment. In this case, both clinical and surgical treatments led to complete resolution of the symptoms.

Expert’s comment concerning Grand Rounds case entitled “Lead toxicity and management of gunshot wounds in the lumbar spine” (by B. Rentfrow, R. Vaidya, C. Elia, A. Sethi doi:10.1007/s00586-013-2805-6)

“…Some authors have recommended the routine removal of metallic projectiles located within the intervertebral disc [5]. However, I agree with other authors who feel that lead toxicity due to retained bullet fragments in the spine after GSW is too rare to justify the morbidity associated with routine removal of bullet fragments for this specific reason alone in asymptomatic patients [3].…”

“…One of these citations is mentioned by the authors (Scuderi et al [3]). Other reports, by Grogan and Bucholz [4] and by Cristante et al [5] have been cited below. A common theme exists between the current case report and each of the prior reports.…”

Enterococcus faecalis causing delayed spondylodiscitis in a case with retained intraspinal bullet

“…Our case had no neurological deficit hence in view of the risk of migration of projectile we did not perform a MRI which could have useful in the preoperative evaluation. Delayed presentations in cases with retained projectiles have been reported previously (8)(9)(10). These include lead intoxication and new onset neurological dysfunction following late migration of projectile.…”

“…They have a high incidence of wound infection especially when they are accompanied by large bowel perforations (5)(6)(7). Delayed presentation following gunshot injuries are reported less frequently and result in late onset neurological dysfunction due to migration of retained projectile and lead intoxication (8)(9)(10). We present a unique late onset presentation following a civilian GSW with colonic perforation that presented 4months following injury with late onset spondylodiscitis associated with a retained intraspinal bullet.…”

Civilian gunshot wounds of the spine: A literature review

“…There are but a few case reports on lead toxicity with bullets or fragments in the spinal canal surrounded by cerebrospinal fluid, or from bullets in the disc space [44][45][46][47][48][49] ( Figure 4).…”