Encephalopathy from lead poisoning masquerading as a flu-like syndrome in an autistic child.
Acute encephalopathy from childhood lead poisoning is fortunately rare. However, in pediatric patients with developmental disabilities and pica, there is a risk of lead exposure at a dose commensurate with encephalopathy, coupled with a risk of delayed diagnosis because of difficulty in distinguishing between baseline and altered behavior. We report here a 4-year old autistic boy who presented to the pediatrician's office with gastrointestinal symptoms and behavioral changes and was at first thought to have a viral syndrome. He returned 2 days later with a worsening illness; increasing pallor, vomiting, abdominal colic, and changes in consciousness were recognized in the emergency department as lead-induced anemia and encephalopathy, associated with a positive abdominal film for paint chips and a blood lead level equal to 216 microg/dL (10.43 micromol/L) (reference, <10 microg/dL or 0.483 micromol/L). As this case illustrates, prompt recognition is dependent on the skills and suspicions of an astute clinician, especially in the busy emergency department.
George
Mathew
M
Harvard Medical Toxicology Program, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. Drmg456@gmail.com
Heeney
Matthew M
MM
Woolf
Alan D
AD
D001321:Autistic Disorder / Q000150:complications*; D002614:Chelating Agents / Q000627:therapeutic use; D015913:Chelation Therapy / Q000379:methods; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis*; D015278:Intensive Care Units, Pediatric; D020264:Lead Poisoning, Nervous System, Childhood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male
D002614:Chelating Agents