Plumbism or lead intoxication mimicking an abdominal tumor

Abstract

The clinical presentation of lead intoxication may vary widely and in the absence of a high clinical index of suspicion, the diagnosis may be missed. The effects of lead on mitochondrial oxidative phosphorylation and its interaction with calcium-mediated processes explain the heterogenous presentation. In this case report, the diagnosis was finally made when bilateral wrist drop developed on top of abdominal cramps and anemia. Before, ascites raised the suspicion of a tumor. Therefore, each element of the triad of unexplained anemia, abdominal cramps, and bilateral wrist (or foot) drop should lead any physician to consider the diagnosis of lead intoxication. This case also illustrates the importance of a careful and meticulous social history in patient management.

FIGURE 1

Basophilic stippling on red blood cells. Basophilic stippling of red blood cells is due to ribosomal aggregation. Although this is not specific for lead poisoning, the diagnostic possibilities are confined to only a few other conditions: pyrimidine 5′ nucleotidase deficiency, thalassemia, and vitamin B12 deficiency.

FIGURE 2

Bilateral wrist drop. The predominant involvement of distal extensor muscles is typical of lead neuropathy. This figure illustrates the inability of the patient to extend the wrist in order to lift the coin from the table.