The rare association between Saturnism and Pseudogota

Authors

DOI:

https://doi.org/10.33448/rsd-v10i6.15967

Keywords:

Lead poisoning; Saturnism; Pseudogota; Calcium Pyrophosphate Deposit Disease.

Abstract

Report the case of a 51-year-old man, who evolved insidiously with tetraparesis after firearm cervical injury 19 years ago, presenting with polyarthralgia, headache, abdominal pain, constipation, polyneuropathy and anemia. Given the diagnostic hypothesis of lead poisoning due to the high serum and urinary levels of lead, surgical removal of projectile in the cervical region was chosen, obtaining clinical improvement. After 5 months, he was readmitted with a relapse of the abdominal and anemic symptoms. Abdomen tomography revealed a possible projectile fragment on right rectus abdominis muscle. On hospitalization, he presented fever, polyarthralgia with fist monoarthritis and phlogistic signs on left bulging elbow, which was punctured. Literature review shows increased reabsorption of uric acid on lead poisoned patients added to the patient antecedent of Gout so we decide to treat the patient with anti-inflammatory drugs and prednisone, with clinical improvement. The study of liquid revealed calcium pyrophosphate crystals, contrasting gouty arthritis diagnosis. Patient underwent surgery to remove the projectile in the rectus abdominis muscle,  we decided not to prescribe chelating, due to the serum lead level below 50 mcg/dl and clinical patient improvement, who was discharged a few days later. We report this case due to the rarity of this association. We hope to raise a possible association of these pathologies with an unknown pathophysiological mechanism not yet described in medical clinic books and with only one case published in world literature.

References

Almeida et al.(2010). Uso de EDTACaNa2 por via intramuscular no tratamento de intoxicação por chumbo: a propósito de um caso clínico. Revista Brasileira de Toxicologia, 23(1-2), 28-34.

Cavaleiro-Costa, R.; Stape, C.A. & Suzuki, I.(1994). Saturnismo causado por projétil de arma de fogo no quadril. Rev Bras Ortop, 29(6), 374-378.

Dalvi, S.R. & Phillinger, M.H.(2013). Saturnine gout, redux: a review. The American Journal of Medicine, 126(5), 450-458.

Daniel, W.W. & Wess, S.J.(1983). Intra-articular milk of calcium in saturnine gout. Radiology, 137, 389-392.

Ludke, M. & Andre, M. E . D. A. (2013). Pesquisas em educação: uma abordagem qualitativa. São Paulo: E.P.U.

Madureira et al.(2009). Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report. São Paulo Medical Journal, 127(1), 52-54.

Mayo Clinic.(2019). Lead Poisoning, Definition. http://www.mayoclinic.org/diseases-conditions/lead-poisoning/basics/definition/con-20035487

Mayo Clinic.(2019). Lead Poisoning, Test and diagnostics. http://www.mayoclinic.org/diseases-conditions/lead-poisoning/basics/tests-diagnosis/con-20035487

Mayo Clinic,(2019). Lead Poisoning, TreatmentsandDrugs. http://www.mayoclinic.org/diseases-conditions/lead-poisoning/basics/treatment/con-20035487

McCarty, D.J.; Kohn, N.N. & Faires, J.S.(1962). The significance of calcium phosphate crystals in the synovial fluid of arthritis patients: the “pseudogout syndrome”: I. Clinical aspects. Ann Intern Med, 56, 711.

Montes-Santiago, J.(2013). The lead-poisoned genius: Saturnism in famous artists across five centuries. In Stanley Finger, Dahlia W. Zaidel, François Boller and Julien Bogousslavsky. Progress in Brain Research, 203, 223-240.

Moreira, F.R. & Moreira, J. C.(2004). A cinética do chumbo no organismo humano e sua importância para a saúde. Ciência & Saúde Coletiva, 9(1), 167-181.

Moreno, A. & Granada, J.(2012). Intoxicación por plomo: diagnóstico diferencial de dolor abdominal crónico. Reporte de caso y revisión de tema. Universitas Médica, 53(2), 199-207.

Pereira, A.S et al.(2018). Metodologia do Estudo de Caso. Metodologia da pesquisa científica. Ed. UAB/NTE/UFSM, 63-74.

Rentfrow et al.(2013). Lead toxicity and management of gunshot wounds in the lumbar spine. European Spine Journal, 22(11), 2353-2357.

Robinson, P.C. & Horsburgh, S.(2014). Gout: Joints and beyond, epidemiology, clinical features, treatment and co-morbidities. Maturitas, 78(4), 245-251.

Sadao, M.(2002). Intoxicação por chumbo. Revista de Oxidologia , 37-42.

Salgado, P.E.T.(2003). Metais em Alimentos. Fundamentos de Toxicologia, 2, 411-415.

Smith, D.R. & Osterloh, J.D. & Flegal, A.R.(1996). Use of Endogenous, Stable Lead Isotopes to Determine Release of Lead from the Skeleton. Environmental Health Perspectives, 104(1), 60-66.

Steinbach, L.S. & Resnick, D.(2000). Calcium pyrophosphate dihydrate crystal deposition disease: imaging perspectives. Curr Probl Diagn Radiol, 29(6), 209-29.

Tsui, F.W.(2012). Genetics and Mechanisms of Crystal Deposition in Calcium Pyrophosphate Deposition Disease. Current Rheumatology Reports. 14(2), 155-160.

Valente et al.(2014). Saturnismo por retenção de projétil de arma de fogo em articulação: relato de caso. Revista da Sociedade Brasileira de Clínica Médica, 12(1), 64-68.

Zhang, W. et al.(2011). European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Annals of Rheumatic Diseases: The EULAR Journal, 70(4), 563-570.

Published

01/06/2021

How to Cite

PONTE, Átila C. B.; MELO, L. R. .; DIAS, L. V. R.; PEREIRA, L. D. M.; COSTA, F. A. M. da .; AUGUSTO, K. L. The rare association between Saturnism and Pseudogota. Research, Society and Development, [S. l.], v. 10, n. 6, p. e29410615967, 2021. DOI: 10.33448/rsd-v10i6.15967. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/15967. Acesso em: 18 jun. 2021.

Issue

Section

Health Sciences