title: Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report.
abstract: BACKGROUND
  Lead poisoning due to retained gunshot bullets is a well-known clinical problem that is fairly frequently described in the literature. The risk factors for this occurrence relate mainly to whether the lead bullet is in contact with the joint fluid or cerebrospinal fluid (CSF). The treatment for these cases entails chelation therapy while symptoms are shown and definitive surgical removal of the bullet as a potential source of lead. The aim of this paper is to describe a clinical case of lead poisoning due to a retained gunshot bullet in contact with CSF.
  
  
  METHODS
  A 42-year-old male was hit by gunshot bullets during a holdup, and one of them was retained in the spinal cord. Six years later, he developed intense low back pain and underwent laminectomy. Nine years later, he then underwent arthrodesis on L5-S1, but he developed intense abdominal pain after the surgical procedure. For five years, he was treated with calcium versenate in five-day cycles, with a good response. The chelation therapy cycles showed great efficacy during symptomatic periods, thus reducing the symptoms and signs of poisoning and promoting great amounts of lead excretion, thereby reducing the total lead burden responsible for the symptoms. Fortunately, over the last four years, the symptoms have improved and the urine levels of aminolevulinic acid (ALA) have declined, to reach complete normalization. This shows that a healing process is probably taking place on the spinal wound, thereby isolating the bullet fragments from CSF contact.
authors.affiliation: Poisoning Control Center, Hospital das Clínicas, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. madu11@fcm.unicamp.br
authors.forename: Paulo Roberto de
authors.initials: PR
authors.lastname: Madureira
authors.forename: Eduardo Mello
authors.initials: EM
authors.lastname: De Capitani
authors.forename: Ronan José
authors.initials: RJ
authors.lastname: Vieira
authors.forename: Alice Momoyo
authors.initials: AM
authors.lastname: Sakuma
authors.forename: Adriana Safioti
authors.initials: AS
authors.lastname: Toledo
authors.forename: Suely Moreira
authors.initials: SM
authors.lastname: Mello
mesh_terms: D000328:Adult; D002614:Chelating Agents / Q000627:therapeutic use; D015913:Chelation Therapy; D004492:Edetic Acid / Q000627:therapeutic use; D006801:Humans; D007855:Lead Poisoning / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000209:etiology*; D020265:Lead Poisoning, Nervous System, Adult / Q000209:etiology; D008297:Male; D014948:Wounds, Gunshot / Q000150:complications*
chemical_list: D002614:Chelating Agents; D004492:Edetic Acid