Dedeken Peter, Louw Vernon, Vandooren Ann-Karolien, Verstegen Geert, Goossens Willy, Dubois Bénédicte
Department of Neurology, University Hospital Gasthuisberg, Leuven, Belgium.
J Gen Intern Med. 2006 Jun;21(6):C1-3. doi: 10.1111/j.1525-1497.2006.00328.x.
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.
铅中毒的临床表现可能差异很大,若临床怀疑指数不高,可能会漏诊。铅对线粒体氧化磷酸化的影响及其与钙介导过程的相互作用解释了这种异质性表现。在本病例报告中,在出现腹部绞痛和贫血的基础上又出现双侧腕下垂时,最终做出了诊断。在此之前,腹水引发了对肿瘤的怀疑。因此,不明原因的贫血、腹部绞痛和双侧腕(或足)下垂三联征的每一个要素都应促使医生考虑铅中毒的诊断。本病例还说明了在患者管理中仔细和详尽的社会史的重要性。