Galindo Christian, Ortiz Juliana, Angel María Fernanda, Ospina Lopera Stephanie, Franco Julio
Psychiatry, Corporación Universitaria Remington, Medellín, COL.
Medical School, Corporación Universitaria Remington, Medellín, COL.
Cureus. 2025 May 6;17(5):e83574. doi: 10.7759/cureus.83574. eCollection 2025 May.
Lead toxicity is a rare but potentially serious clinical condition that can manifest with a wide range of neuropsychiatric and systemic symptoms. We present the case of a 29-year-old male patient from Medellín, Colombia, who experienced delayed-onset neuropsychiatric symptoms secondary to chronic lead exposure from a retained bullet fragment in the left ankle, following a firearm injury sustained 13 years earlier. The patient initially presented with essential tremor in both upper and lower limbs, nausea, vomiting, subjective fever, a metallic taste in the mouth, mood disturbances, significant unintentional weight loss, and chronic mixed-type ankle pain with localized edema. A blue line on the gums (Burton's line) was observed on physical examination, raising suspicion for lead poisoning. Blood lead level testing confirmed severely elevated levels, supporting the diagnosis of chronic lead intoxication. Additional laboratory tests revealed moderate to severe normocytic anemia and transiently elevated serum creatinine. Despite the persistence of symptoms for approximately three years, diagnosis and treatment were delayed. The bullet was surgically removed after approximately seven months of clinical deterioration. The case highlights the systemic impact of chronic lead exposure and the importance of recognizing non-occupational sources, such as retained ammunition fragments, as potential causes. This report emphasizes the need for early recognition of atypical neuropsychiatric presentations, particularly in patients with a history of trauma or exposure to heavy metals. It also reinforces the relevance of integrating clinical findings with occupational and environmental history to guide diagnosis. Lead intoxication remains a significant public health issue, especially in regions with limited regulation or awareness, and should be considered in the differential diagnosis of unexplained systemic and cognitive symptoms.
铅中毒是一种罕见但可能严重的临床病症，可表现出广泛的神经精神和全身症状。我们报告一例来自哥伦比亚麦德林的29岁男性患者，他在13年前遭受火器伤后，因左脚踝留存的子弹碎片导致慢性铅暴露，出现了迟发性神经精神症状。患者最初表现为上下肢原发性震颤、恶心、呕吐、主观发热、口中有金属味、情绪障碍、明显的非故意体重减轻以及伴有局部水肿的慢性混合型脚踝疼痛。体格检查时发现牙龈上有蓝线（伯顿线），这引发了对铅中毒的怀疑。血铅水平检测证实血铅水平严重升高，支持慢性铅中毒的诊断。其他实验室检查显示中度至重度正细胞性贫血以及血清肌酐短暂升高。尽管症状持续了大约三年，但诊断和治疗都被延误了。在临床恶化大约七个月后，子弹被手术取出。该病例突出了慢性铅暴露的全身影响以及认识到非职业性来源（如留存的弹药碎片）作为潜在病因的重要性。本报告强调需要早期识别非典型神经精神表现，尤其是有创伤史或接触重金属史的患者。它还强化了将临床发现与职业和环境史相结合以指导诊断的相关性。铅中毒仍然是一个重大的公共卫生问题，特别是在监管或认识有限的地区，在不明原因的全身和认知症状的鉴别诊断中应予以考虑。
