Étude d’un cas clinique : saturnisme chronique suite à un traumatisme balistique

Abstract : Introduction: saturnism is a disease related to an acute or chronic intoxication to lead or its derivatives of household or occupational origin. A less known source of exposure is ammunition containing this metal. While early management of lead toxicity is fundamental, prevention and diagnosis are challenging. The project presented hereafter explores the clinical case of a patient with a chronic lead poisoning following firearm injury and is based on a literature review. The aim of the study was to identify predictive factors of saturnism and the required monitoring in patients with retained missiles. Methods: this is a clinical case study of M. Z., aged 38 years, with chronic intoxication by lead due to ballistic trauma. The kinetics of blood-lead level (PbB) were unusual in this patient compared with cases reported in the literature. Results: M.Z presented with a very high PbB, 104.8 µg/dL, at day 8 after the injury. The maximum level was reached at day 15 with a dose of 203.2 µg/dL. A second PbB peak was reached at 4 months with 165 µg/dL. Only a double chelation with EDTA and long-term Succicaptal treatment allowed obtaining a lead level lower than 40 µg/dL. This clinical picture is commonly related to a projectile/bullet composed of exclusively soft lead. Levels of ALA-u, an indicator of recent lead exposure, increased quickly and substantially to reach a maximum level of 164 µg/dL of creatinine at day 10. The subsequent decrease of creatinine levels is related to treatment with EDTA Similar cases have been reported in the literature, with a PbB increase during the first 3 months followed by a progressive decrease in the next 9 months rarely exceeding 50 µg/dL. Conclusion: a year following the ballistic trauma, in the absence of lead poisoning symptoms or intercurrent events likely to increase the lead level, no further examination was necessary. Physicians treating patients with internal lead have to be informed in order not to overlook current risk and to avoid forthcoming intoxications. It is essential to rapidly dose PbB in patients with symptoms suggestive of lead poisoning. An early intervention allows efficiently treating these patients who are often misdiagnosed as well as avoiding treatment delay and the onset of chronic complications.
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Master Thesis
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Camille Pelou. Étude d’un cas clinique : saturnisme chronique suite à un traumatisme balistique. Médecine humaine et pathologie. 2018. ⟨dumas-02062414⟩

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