Lead poisoning by intradiscal firearm bullet: a case report.
METHODS
The report of a rare case of lead poisoning by an intradiscal firearm bullet is presented.


OBJECTIVE
To describe and discuss the clinical and radiologic features (by computed tomography and magnetic resonance imaging) of a gunshot wound in the L2-L3 space which caused lead poisoning 5 years afterwards.


BACKGROUND
Lead poisoning from firearm bullets is rare, but the possibility should be investigated in the case of bullets lodged in the joints.


METHODS
A 30-year-old man presented to the emergency room with an intense lumbar pain complaint, colic, intestinal constipation, insomnia, and progressive headache for 20 days. He had a history of a gunshot wound 5 years previously, and the bullet was left in situ, in the intravertebral disc between L2 and L3, as confirmed by radiographs, computed tomography, and magnetic resonance imaging. The hypothesis of lead poisoning was confirmed by the laboratory results. Chelation treatment with calcium versenate (disodium ethylenediaminetetraacetate, or CaNa (2) EDTA) was indicated. The patient was admitted and treated once again, before surgical removal of the bullet.


RESULTS
After removal of the bullet, the patient had an episode of recurrence, and a new chelation cycle was performed, with complete resolution.


CONCLUSIONS
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.
Cristante
Alexandre F
AF
From the Spine Division, Department of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), São Paulo, Brazil. aacristante@uol.com.br
de Souza
Fabiano I
FI
Barros Filho
Tarcisio E P
TE
Oliveira
Reginaldo P
RP
Marcon
Raphael M
RM
D000328:Adult; D002614:Chelating Agents / Q000627:therapeutic use; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000293:injuries*; D007855:Lead Poisoning / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications* / Q000000981:diagnostic imaging
D002614:Chelating Agents