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Lead poisoning by intradiscal firearm bullet: a case report.

Spine 2010 Februrary 16
STUDY DESIGN: The report of a rare case of lead poisoning by an intradiscal firearm bullet is presented.

OBJECTIVE: To describe and discuss the clinical and radiologic features (by computed tomography and magnetic resonance imaging) of a gunshot wound in the L2-L3 space which caused lead poisoning 5 years afterwards.

SUMMARY OF BACKGROUND DATA: Lead poisoning from firearm bullets is rare, but the possibility should be investigated in the case of bullets lodged in the joints.

METHODS: A 30-year-old man presented to the emergency room with an intense lumbar pain complaint, colic, intestinal constipation, insomnia, and progressive headache for 20 days. He had a history of a gunshot wound 5 years previously, and the bullet was left in situ, in the intravertebral disc between L2 and L3, as confirmed by radiographs, computed tomography, and magnetic resonance imaging. The hypothesis of lead poisoning was confirmed by the laboratory results. Chelation treatment with calcium versenate (disodium ethylenediaminetetraacetate, or CaNa (2) EDTA) was indicated. The patient was admitted and treated once again, before surgical removal of the bullet.

RESULTS: After removal of the bullet, the patient had an episode of recurrence, and a new chelation cycle was performed, with complete resolution.

CONCLUSION: Lead poisoning can result in severe clinical disorders that require rapid treatment. In this case, both clinical and surgical treatments led to complete resolution of the symptoms.

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