title: Severe lead toxicity attributed to bullet fragments retained in soft tissue.
abstract: A man aged 30 years presented to an emergency department with a 1 month history of severe abdominal pain, jaundice, constipation, lower extremity weakness and weight loss. A peripheral blood smear was performed that showed basophilic stippling of erythrocytes prompting a blood lead level (BLL) evaluation. The patient had a BLL of >200 µg/dL. Retained bullet fragments were identified in the left lower extremity from a previous gunshot wound 10 years prior. Lead from the excised bullet fragment was consistent with the patient's blood lead by isotope ratio analysis. This case is a rare example of a severely elevated BLL attributed to bullet fragments in soft tissue. Bullets retained in soft tissue are not often considered a risk factor for a markedly elevated BLL because they become encapsulated within the tissue over time.
authors.affiliation: Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services (CSELS), Atlanta, Georgia, USA.|Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, Madison, Wisconsin, USA.
authors.forename: Debora
authors.initials: D
authors.lastname: Weiss
authors.affiliation: Ascension Columbia St. Mary's, Milwaukee, Wisconsin, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Lee
authors.affiliation: Wisconsin Poison Center, Childrens Hospital of Wisconsin, Froedert & the Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Feldman
authors.affiliation: University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Trace Element Research Laboratory, Madison, Wisconsin, USA.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Smith
mesh_terms: D000328:Adult; D019468:Disease Management; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007855:Lead Poisoning / Q000097:blood* / Q000209:etiology; D008297:Male; D014948:Wounds, Gunshot / Q000150:complications*