Kirchgatterer A, Rammer M, Knoflach P
I. Interne Abteilung mit Gastroenterologie und Hepatologie, Diabetologie und Rheumatologie, Klinikum Kreuzschwestern Wels GmbH, Wels, Osterreich.
Dtsch Med Wochenschr. 2005 Oct 7;130(40):2253-6. doi: 10.1055/s-2005-918557.
A 58-year-old woman with type 1 diabetes and coronary artery disease was admitted to hospital because of diminished appetite, weight loss, abdominal pain and anemia. Earlier treatment of duodenal ulcer and cholecystectomy had not achieved sustained relief. On physical examination paleness and general weakness was noted.
Laboratory tests showed a normocytic, normochromic anemia, anisocytosis, polychromasia and basophilic stippling of erythrocytes. Bone marrow examination revealed a hyperreactive erythropoesis with basophilic stippling of erythrocytes and incomplete differentiation of erythroid progenitor cells. Inherited or acquired enzymopathies of erythrocytes were ruled out. Urinary collection showed remarkable elevation of porphyrin concentration.
DIAGNOSIS, TREATMENT AND COURSE: Suspected poisoning was confirmed by elevated lead concentrations in whole-blood (85.8 microg/dl) and urine (106.3 microg/l). A souvenir of Rhodes, a ceramic mug with lead-containing glaze, was identified as the source of the lead poisoning, the lead dissolving into hot tea put in the mug. Treatment with D-penicillamine was begun, and within five weeks anemia disappeared and the patient achieved complete resolution of symptoms.
Recognition of the cause of lead poisoning is of critical importance. This case report demonstrates difficulties in diagnosing and identifying the source of poisoning.
一名患有1型糖尿病和冠状动脉疾病的58岁女性因食欲减退、体重减轻、腹痛和贫血入院。十二指肠溃疡的早期治疗和胆囊切除术未能取得持续缓解。体格检查发现面色苍白和全身虚弱。
实验室检查显示为正细胞正色素性贫血、红细胞大小不均、多染性及嗜碱性点彩。骨髓检查显示红细胞生成反应性增高,伴有红细胞嗜碱性点彩及红系祖细胞分化不完全。排除了遗传性或获得性红细胞酶病。尿液检查显示卟啉浓度显著升高。
诊断、治疗及病程:全血(85.8微克/分升)和尿液(106.3微克/升)中铅浓度升高证实了疑似中毒。一个来自罗德岛的纪念品,一个带有含铅釉面的陶瓷杯,被确定为铅中毒的源头,铅溶解于倒入杯中热茶中。开始用D-青霉胺治疗,五周内贫血消失,患者症状完全缓解。
认识铅中毒的病因至关重要。本病例报告显示了诊断和确定中毒源头的困难。