Tsai Ming-Ta, Huang Shi-Yu, Cheng Shih-Yu
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Case Rep Emerg Med. 2017;2017:9050713. doi: 10.1155/2017/9050713. Epub 2017 May 29.
Lead poisoning (LP) is less commonly encountered in emergency departments (ED). However, lead exposure still occurs, and new sources of poisoning have emerged. LP often goes unrecognized due to a low index of suspicion and nonspecific symptoms. We present a case of a 48-year-old man who had recurring abdominal pain with anemia that was misdiagnosed. His condition was initially diagnosed as nonspecific abdominal pain and acute porphyria. Acute porphyria-like symptoms with a positive urine porphyrin test result led to the misdiagnosis; testing for heme precursors in urine is the key to the differential diagnosis between LP and acute porphyria. The final definitive diagnosis of lead toxicity was confirmed based on high blood lead levels after detailed medical history taking. The lead poisoning was caused by traditional Chinese herbal pills. The abdominal pain disappeared after a course of chelating treatment. The triad for the diagnosis of lead poisoning should be a history of medicine intake, anemia with basophilic stippling, and recurrent abdominal pain.
铅中毒（LP）在急诊科较少见。然而，铅暴露仍有发生，且出现了新的中毒源。由于怀疑指数低和症状不具特异性，铅中毒常未被识别。我们报告一例48岁男性病例，该患者反复腹痛伴贫血，曾被误诊。其病情最初被诊断为非特异性腹痛和急性卟啉病。尿卟啉试验结果呈阳性的急性卟啉病样症状导致了误诊；检测尿中的血红素前体是鉴别铅中毒和急性卟啉病的关键。在详细询问病史后，根据高血铅水平确诊为铅中毒。铅中毒是由中药丸引起的。经过一个疗程的螯合治疗后，腹痛消失。铅中毒诊断的三联征应为用药史、伴有嗜碱性点彩的贫血和反复腹痛。
