Rhabdomyolysis and muscle necrosis induced by lead poisoning

Ansari, Behnaz; Dorooshi, Gholamali; Lalehzar, Sahar Sadat; Taheri, Abolfazl; Meamar, Rokhsareh

Rhabdomyolysis and muscle necrosis induced by lead poisoning

Document Type : CASE REPORT

Authors

¹ Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

² Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

³ Health Information Technology Research Center, Clinical Informationist Research Group, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

A case is presented on a 40-year-old male with chronic lead poisoning with loss of consciousness, rhabdomyolysis, and acute renal failure after occupational exposure. Physical examination revealed generalized atrophy, tenderness, and swelling in the right limb and a decreased proximal muscle strength in the lower limb. A severe acute polyradiculoneuropathy in lower limbs documented by electromyography. All paraclinical tests were normal except increased blood lead level (75 μg/dl) and blue line in gum of the teeth. The patient was treated with penicillamine (500 mg q8 h) and pyridoxine (50 mg daily) for 8 months, only accessible drug in Iran. Force of patient's muscles in the proximal part of the lower limb was improved, and also the blood lead level reached to normal range. This is the first patient with rhabdomyolysis and muscle necrosis induced by lead poisoning.

Keywords

References

1.	Andjelkovic M, Buha Djordjevic A, Antonijevic E, Antonijevic B, Stanic M, Kotur-Stevuljevic J, et al. Toxic effect of acute cadmium and lead exposure in rat blood, liver, and kidney. Int J Environ Res Public Health. 2019;16:274.
2.	Needleman H. Lead poisoning. Annu Rev Med 2004;55:209-22.
3.	Staudinger KC, Roth VS. Occupational lead poisoning. Am Fam Physician 1998;57:719-26,731-2.
4.	Keramati MR, Nemai Ghasemi M, Balali-Mood M: Correlation between iron deficiency and lead intoxication in the workers of a car battery manufacturer. J Birjand Univ Med Sci 2009;16:51-8.
5.	Mason LH, Mathews MJ, Han DY. Neuropsychiatric symptom assessments in toxic exposure. Psych Clin 2013;36:201-8.
6.	Majchrzak M, Celiński R, Kowalska T, Sajewicz M. Fatal case of poisoning with a new cathinone derivative: α-propylaminopentiophenone (N-PP). Forensic Toxicol, 2018;36:525-33.
7.	Rubens O, Logina I, Kravale I, Eglîte M, Donaghy M. Peripheral neuropathy in chronic occupational inorganic lead exposure: A clinical and electrophysiological study. J Neurol Neurosurg Psychiatry 2001;71:200-4.
8.	Thomson RM, Parry GJ. Neuropathies associated with excessive exposure to lead. Muscle Nerve 2006;33:732-41.
9.	Fernandes PM, Davenport RJ. How to do it: Investigate exertional rhabdomyolysis (or not Pract neurol 2019;19:43-8.
10.	Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M. Rhabdomyolysis: Review of the literature. Neuromuscular Disorders 2014;24:651-9.
11.	Mason LH, Harp JP, Han DY. Pb neurotoxicity: Neuropsychological effects of lead toxicity. BioMed Res Int, 2014;1-8.
12.	Wu ML, Deng JF, Lin KP, Tsai WJ. Lead, mercury, and arsenic poisoning due to topical use of traditional Chinese medicines. Am J Med 2013;126:451-4.
13.	Srisuma S, Lavonas EJ, Wananukul W. Proximal muscle weakness in severe lead poisoning from retained bullet fragments. Clinical toxicology 2015;53:586-7.
14.	Kazzi ZN. Critical care toxicology: Diagnosis and management of the critically poisoned patient. Ann Emerg Med 2005;46:302-3.
15.	Beigmohammadi MT, Aghdashi M, Najafi A, Mojtahedzadeh M, Karvandian K. Quadriplegia due to lead-contaminated opium--case report. Middle East J Anaesthesiol 2008;19:1411-6.
16.	Mesri M, Najari F, Baradaran Kayal I, Najari D. Hyper acute quadriplegia with chronic lead toxicity; a case report. Emergency 2018;6:1-4.
17.	Keary CJ, Wang Y, Moran JR, Zayas LV, Stern TA. Toxicologic testing for opiates: Understanding false-positive and false-negative test results. Prim Care Companion CNS Disord, 2012;14:51-8.
18.	Fucci N. EMIT dau: Methadone false positive with creatinine interference. Forensic Sci Int 2005;148:81.
19.	Gidlow D. Lead toxicity. Occupational Medicine 2015;65:348-56.
20.	Moss M, Cooper P. Gasoline sniffing and lead poisoning. Acta Pharmacol Toxicol 1986;59:48-51.
21.	Becerra L, Colorado M, Molina J, Rivera A, Mesa M, Velásquez-Franco CJ, Muñoz-Grajales C. Co-existence of peripheral neuropathy secondary to lead poisoning and chronic polymyositis: Case report. Revista Colombiana de Reumatología (English Edition), 2016;23:213-7.
22.	Karrari P, Mehrpour O, Abdollahi M. A systematic review on status of lead pollution and toxicity in Iran; Guidance for preventive measures. DARU Journal of Pharmaceutical Sciences. 2012;20:20-37.

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