Case Report: Severe lead poisoning due to exposure to ayurvedic herbal medicine

Abstract

Introduction: Lead is an environmental toxin that may cause severe damage to vital organs including the brain, kidneys, liver, and bones. Children are particularly susceptible due to higher rates of gastrointestinal absorption and detrimental effects of lead on their developing nervous systems.

Methods: This report highlights the case of a 4-year-old boy with severe lead poisoning resulting from prolonged exposure to ayurvedic herbal supplements.

Results: The child was initially admitted with anemia, arterial hypertension, abdominal pain, and mild neurological impairment. His blood smear revealed pronounced basophilic stippling of erythrocytes. His venous blood lead level (BLL) was markedly elevated at 123 μg/dl. Detailed review of his history uncovered that he had been ingesting an ayurvedic herbal medicine for asthma. He received chelation therapy with 2,3-dimercapto-1-propanesulfonic acid and calcium disodium EDTA, resulting in rapid resolution of symptoms and gradually decreasing BLLs.

Conclusions: The case is a striking example of the significant health risks due to heavy metal contamination in ayurveda products. Better strategies to control the composition of ayurvedic products and educate families about their possible heavy metal contamination are essential to reduce the risk of lead poisoning.

Keywords: ayurvedic medicine; chelation therapy; complementary and alternative medicine; heavy metal toxicity; lead poisoning; pediatric environmental health.

Figure 1

Hematology findings. The patient presented with normochromic anemia. (A) Giemsa-stained peripheral blood showed marked basophilic stippling of erythrocytes. (B) The bone marrow was normocellular with adequate representation of megakaryocytes. Both images are shown at 600×.

Figure 2

Lead poisoning. The patient ingested an ayurvedic herbal medicine termed Indian spices. (A) The Indian spices were provided as a brown powder wrapped in filter paper. (B) The packets were found to be radio-opaque. (C) The powder contained crystalline elements. (D) An x-ray of the wrist demonstrated a lead line in the distal radius metaphysis (marked by a red arrow). (E) Blood lead levels slowly decreased after initiation of chelation therapy with intravenous 2,3-dimercapto-1-propanesulfonic acid (DMPS, denoted by a grey bar) and subsequent intravenous CaNa₂EDTA administration in 5-day cycles (start of CaNa₂EDTA cycles marked by red arrows). One dose of oral DMPS was administered (marked by a grey circle). Intravenous DMPS was discontinued due to development of erythema multiforme; oral DMPS was discontinued after a single dose because of an allergic reaction. The gray bar indicates the period of intravenous DMPS therapy, the gray circle indicates the single dose of oral DMPS, and the red arrows indicate the start of CaNa₂EDTA cycles.