Journal de toxicologie clinique
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Cognitive Complications in a Case of Chronic Non-Occupational Lead Intoxication: A Case Report

Alessandra Deini, Maru dell’Omo, Dany Lillacci, Chiara Pucci, Cristiana Gambelunghe, Mauro Zampolini, Angela Gambelunghe*

Cases of lead poisoning in adulthood are predominantly of occupational origin while, in childhood, poisoning from domestic sources is more common, especially in the presence of behavioral disorders (e.g., pica). This case report examines the case of a 52-year-old man with non-occupational lead exposure and a silent neuropsychiatric history. The onset clinical picture was characterized by asthenia, generalized malaise, abdominal pain and anemia, which appeared within the preceding 2 months. He was admitted following the appearance of neurological symptoms (confusional state, balance disturbances, memory disorders) and initially evaluated to rule out myeloproliferative diseases and gastrointestinal causes of blood loss. Among the required investigations were performed: A total-body CT scan which showed “hyperdense punctiform images, with bone density, probably attributable to ingestion” and a peripheral venous blood smear that showed “anisocytosis and anisochromia compatible but not pathognomonic for lead anemia”. It was only then that the patient's hobby became known: He produced lead fishing sinkers himself, which were attached to the fishing line with his teeth. Some of these were accidentally ingested and led to chronic intoxication (first detected lead value 546 ug/l). Neuroradiological and neurocognitive examinations performed documented selective deficits in verbal memory, logorrhea and lightly incoherent and inappropriate behavior.