Lead Poisoning, Report of an Interesting Case

Abstract

Lead poisoning has several clinical manifestations so the diagnosis may be troublesome. These manifestations consist of anemia, neurologic abnormalities, liver and biliary tract problems and abdominal pain. Not only opium addiction, but also lead toxicity can cause biliary tract problems.When both etiologies occur at the same time, the diagnosis is difficult. A 46 year old opium addicted man with colicky abdominal pain was referred for more evaluation. In the first hospitalization, he complained of abdominal pain, constipation and weakness. Laboratory data revealed anemia and elevation of ALP. Sonographic exam revealed dilatation of CBD. ERCP revealed also dilation of CBD without concomitant CBD stone. Sphincterotomy was done. After 2 weeks, he came back with the same presentation, but some neurologic abnormalities such as gait disturbance, tremor and proximal weakness were added to his problems. Blood lead level was checked that revealed severe elevation (90 mcg/dl) and the patient was managed properly with lead toxicity diagnosis.Although opium can lead to common bile duct disease, our case, indicated that lead poisoning must be considered even in opium addicted patients, who come with symptoms and signs of common bile duct problems.