Acute lead poisoning in an opium user: a case report

Excess amounts of lead in serum may affect different organ systems and cause lead poisoning. This toxicity mostly happens in chronic and occupational settings. This report comprises the clinical presentation of an acute case of lead toxicity with a much uncommon source of poisoning: opium. A 25 year old man was presented to us with abdominal pain, nausea and vomiting, severe weight loss, generalized bone pain, and jaundice. He had six years history of addiction to oral and inhalation forms of opium. Pallor and jaundice were observed in his mucosa and bluish pigmentation was evident at the gum-teeth line. Hepatosplenomegaly and lymphadenopathy were not detected. Upper GI endoscopy was normal. Liver enzymes and indirect billirubin were increased; however, alkaline phosphatase was in normal range. Laboratory tests were indicative of hemolytic anemia without autoimmune origin. Bone marrow aspiration and biopsy were indicative of erythroid hyperplasia. According to the symptoms and the clinical symptoms of lead poisoning, the lead level was measured both in the serum and in the opium sample the patient used to use. 350mcg/dl of lead in the serum and the very high lead content of the opium sample confirmed the diagnosis; therefore, patient was treated with Calcium-EDTA and BAL that caused decrease of lead level and elimination of symptoms.