Answer: What's your diagnosis? – Case 3

In this week’s “What’s your Diagnosis?” Mr S, a factory worker and former war veteran, presented with strange behaviour. Read the full case report here.

Answer

Mr S suffers from chronic lead poising – most likely caused by the bullet lodged in his back. The original case study does not state in which type of factory he works, but continuous environmental or occupational exposure to lead may be the cause.

Lead poising can manifest in various ways. Cognitive changes may be noted by the patient and his or her family. This includes confusion, delirium or even hallucinations. This will explain Mr S’s strange behaviour and his confusion with time.

Chronic lead exposure may cause weakness of the extensor muscles, causing a foot drop or a wrist drop, which would explain why he dropped a mug.

Sleep disorders are common in lead poising. Sufferers may have difficulty falling asleep at night and may occasionally  have excessive daytime sleepiness.

Mr S’s gout attack can be explained by the fact that chronic lead exposure may cause hyperuricemia (built up of uric acid in the blood) that can precipitate a gout attack.

Lead Poisoning, or heavy metal poisoning, may not be as common today as it was years ago, but should still form part of the differential diagnosis when a patient presents with neurological symptoms.

Summary

Lead poising usually presents with non-specific signs and symptoms. The following is a list of associated symptoms.

Of utmost importance is exposure history, occupational history.

1.       Abdominal pain and cramping

2.       Change in behaviour (aggression, confusion)

3.       Change in sleeping patterns

4.       Loss of appetite

5.       Loss of sensation in periphery

6.       Weakness in periphery: foot or writs drop

If you suspect any possible heavy metal poising, it is of the utmost importance that your doctor examines you. Make your doctor aware of any exposure. 

NOTE: Health24's on-site GP Dr Owen Wiese will reveal new cases on Thursdays. We'll post the answer on Mondays, or you can find out via the Daily Tip – sign up here.

If you liked this case, have a look at our previous case here.

Image: Bullets pouring out of a medical prescription container from Shutterstock