title: Lead Poisoning presenting as acute severe myalgia: Why was the diagnosis delayed and what lessons can we learn as acute physicians?
abstract: Patients presenting to the "front door" with acute neuromuscular symptoms are challenging. Toxins need consideration as possible causative agents if there is the possibility of relevant exposure. This requires a thorough history1 and an awareness of local ethnic, social and industrial cultures within the practice locality. We describe a case of lead poisoning in a 35 year old man who presented with severe, progressive, myalgia. We consider that basic errors in clinical processing delayed a potentially difficult and serious diagnosis and these are discussed. The importance of maintaining a thorough initial clerking process within the Acute Medical Unit is highlighted. This should include a comprehensive occupational history. Acute physicians should familiarize themselves with local industry and the toxic syndromes they can produce.
authors: Hutt Valley District Health Board, Hutt Hospital, High Street, Lower Hutt, Private Bag 31-907 Lower Hutt, 5040 New Zealand;
authors: T
authors: T
authors: Petterson
authors: Jm
authors: J
authors: McLaren
authors: Dcr
authors: D
authors: McGouran