Make the diagnosis, Sherlock!

  3.5 out of 5 stars Case 12-2014: A 59-Year-Old Man with Fatigue, Abdominal Pain, Anemia, and Abnormal Liver Function. Friedman LS et al. N Engl J Med 2014 Apr 17;370:1542-1550. Reference – no abstract available This is from the long-running series “Case Records of the Massachusetts General Hospital.” A 59-year-old man presents to an outpatient clinic with abdominal pain, dysgeusia, constipation, nausea, a new microcytic anemia with basophilic stippling, and behavioral changes. Hepatic transaminases were elevated. Symptoms increased markedly over the next several days. The following are key questions about this case. Click on the question to reveal the answer. What do you think the diagnosis is? expand(document.getElementById('ddet1643140061'));expand(document.getElementById('ddetlink1643140061')) Actually, for a NEJM case puzzler, this one is quite easy. There are not that many conditions that cause basophilic stippling, especially given the new acute presentation at the age of 59. Just on the basis of this consideration, the most likely diagnosis is lead poisoning, which would also explain the gastrointestinal symptoms and the microcytic anemia. The blood lead level in this patient was 91 μg/dl (reference range, 0-9). The zinc protoporphyrin (ZPP) level was elevated. What does this tell us? expand(document.getElementById('ddet1820087073'));expand(document.getElementById('ddetlink1820087073')) Lead inhibits many enzymes that participate in the synt...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical basophilic stippling case records of the massachusetts general hospital lead toxicity new england journal of medicine Source Type: news