Hip pain and heart failure: the missing link.

A man presented with hypothyroidism, dilated cardiomyopathy, a pericardial effusion, liver failure, and polycythaemia. He had a history of bilateral hip replacements and new-onset hip pain. The patient progressed to develop shock. Given his acutely profound illness and constellation of symptoms, as well as the history of hip replacement, a diagnosis of cobalt toxicity was made.