Possível intermediação do sistema imune na polineuropatia periférica plúmbica: relato de caso

Dias-Tosta, Elza; Alves, Adriana; Calmon, Miriam; Colombo, Luiz C.

doi:10.1590/S0004-282X1997000100021

Resumos

Relata-se o caso de paciente de 25 anos com ferimento por arma de fogo na articulação coxo-femural esquerda que desenvolveu, entre outros sinais de intoxicação plúmbica, polineuropatia periférica axonal predominantemente motora. Tratado inicialmente com corticosteróides em doses imunossupressoras obteve melhora, mas apresentava recidiva a cada tentativa de retirada da medicação. Demonstrados laboratorialmente níveis séricos tóxicos de chumbo, foi submetido à quelação com EDTA e à retirada cirúrgica do projétil, com boa recuperação da polineuropatia, sem necessidade ulterior de corticosteróides. Enfatiza-se: 1) o possível papel do sistema imune na fisiopatogenia da intoxicação por chumbo, podendo ser um dos motivos das diferentes apresentações clínicas das neuropatias plúmbicas na infância e no adulto; 2) a importância da retirada do material plúmbeo quando alojado em articulações.

projétil de arma de fogo; chumbo; articulação; polineuropatia periférica; corticosteróides

This is a case report of a twenty-five years old man who developed, due to lead intoxication, a severe axonal peripheral predominantly motor neuropathy, after a shotgun injury. The projectile was retained in the right hip. Before this diagnosis had been done he was treated with corticosteroids in immunosuppressive doses and showed an improvement, but he had worsened at each attempt to interrupt the drug. Because he had also other signs of lead intoxication, such as abdominal cramps, severe anemia and seizures it was search for the blood levels of lead that was 101.2 }μg/dl. The patient was treated with calcium disodium edetate and surgical removal of lead fragments. After that he had a good outcome with no need of corticosteroids. It is emphasized the possible relevance of the immune system on the mechanism of plumbic intoxication and the importance of the withdrawal of the lead material retained in joints.

gunshot; lead; joint; peripheral neuropathy; corticosteroids

Possível intermediação do sistema imune na polineuropatia periférica plúmbica: relato de caso

Possible role of the immune system in lead neuropathy: case report

Elza Dias-Tosta^I; Adriana Alves^II; Miriam Calmon^III; Luiz C. Colombo^II

^IHospital Universitário de Brasília, PhD pela Universidade de Londres

^IIHospital Universitário de Brasília: Neurologista

^IIIHospital Universitário de Brasília: Hematologista

RESUMO

Relata-se o caso de paciente de 25 anos com ferimento por arma de fogo na articulação coxo-femural esquerda que desenvolveu, entre outros sinais de intoxicação plúmbica, polineuropatia periférica axonal predominantemente motora. Tratado inicialmente com corticosteróides em doses imunossupressoras obteve melhora, mas apresentava recidiva a cada tentativa de retirada da medicação. Demonstrados laboratorialmente níveis séricos tóxicos de chumbo, foi submetido à quelação com EDTA e à retirada cirúrgica do projétil, com boa recuperação da polineuropatia, sem necessidade ulterior de corticosteróides. Enfatiza-se: 1) o possível papel do sistema imune na fisiopatogenia da intoxicação por chumbo, podendo ser um dos motivos das diferentes apresentações clínicas das neuropatias plúmbicas na infância e no adulto; 2) a importância da retirada do material plúmbeo quando alojado em articulações.

Palavras-chave: projétil de arma de fogo, chumbo, articulação, polineuropatia periférica, corticosteróides.

ABSTRACT

This is a case report of a twenty-five years old man who developed, due to lead intoxication, a severe axonal peripheral predominantly motor neuropathy, after a shotgun injury. The projectile was retained in the right hip. Before this diagnosis had been done he was treated with corticosteroids in immunosuppressive doses and showed an improvement, but he had worsened at each attempt to interrupt the drug. Because he had also other signs of lead intoxication, such as abdominal cramps, severe anemia and seizures it was search for the blood levels of lead that was 101.2 }μg/dl. The patient was treated with calcium disodium edetate and surgical removal of lead fragments. After that he had a good outcome with no need of corticosteroids. It is emphasized the possible relevance of the immune system on the mechanism of plumbic intoxication and the importance of the withdrawal of the lead material retained in joints.

Key words: gunshot, lead, joint, peripheral neuropathy, corticosteroids.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 16-outubro-1996.

Dra. Elza Dias-Tosta - SHIS QL 16 Conj 5 Casa 17 - 71640-255 Brasília DF - Brasil.

1. Beazley WC, Rosenthal RE. Lead intoxication 18 months after a gunshot wound. Clin Orthop Rel Res 1984; 190:199-203.
2. Borella P, Giardino A. Lead and cadmium at very low doses affect in vitro immune response of human lymphocytes. Environm Res 1991;55:165-177.
3. Dillman RO, Crumb CK, Lidsky MJ. Lead poisoning from a gunshot wound: report of a case and review of the literature. Am J Med 1979;66:509-514.
4. Grogan DP, Bucholz RW. Acute lead intoxication from a bullet in an intervertebral disc space: a case report. J Bone Joint Surg 1981;63-A:1180-1182.
5. He F, Zhang S, Li G, Zhang S, Huang, J, Wu Y. An electroneurographic assessment of subclinical lead neurotoxicity. Int Arch Occup Environm Health 1988;61:141-146.
6. Hermes-Lima M, Pereira B, Bechara JH. Are free radicals involved in lead poisoning ? Review. Xenobiotica 1991;21:1085-1090.
7. Leonard MH. The solution of lead by synovial fluid. Clin Orthop Rel Res 1969;64:255-261.
8. Linden MA, Manton WI, Stewart RM, Thai E, Feit H. Lead poisoning from retained bullets: pathogenesis, diagnosis and management. Ann Surg 1982;195:305-313.
9. Selbst SM, Henretig F, Fee MA, Levy SE, Kitts AW. Lead poisoning in a child with a gunshot wound. Pediatrics 1986;77:413-416.
10. Wedeen RP, Mallik DK, Batuman V. Detection and treatment of occupational lead nephropathy. Arch Intern Med 1979;139:53-57.
11. Windebank AJ. Metal neuropathy. In: Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF. Peripheral neuropathy. Ed 3 Philadelphia: Saunders, 1993:1549-1570.
12. Wu PBJ, Kingery WS, Date ES. An EMG case report of lead neuropathy 19 years after a shotgun injury. Muscle Nerve 1995;18:326-329.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Beazley WC, Rosenthal RE. Lead intoxication 18 months after a gunshot wound. Clin Orthop Rel Res 1984; 190:199-203.

[2] 2. Borella P, Giardino A. Lead and cadmium at very low doses affect in vitro immune response of human lymphocytes. Environm Res 1991;55:165-177.

[3] 3. Dillman RO, Crumb CK, Lidsky MJ. Lead poisoning from a gunshot wound: report of a case and review of the literature. Am J Med 1979;66:509-514.

[4] 4. Grogan DP, Bucholz RW. Acute lead intoxication from a bullet in an intervertebral disc space: a case report. J Bone Joint Surg 1981;63-A:1180-1182.

[5] 5. He F, Zhang S, Li G, Zhang S, Huang, J, Wu Y. An electroneurographic assessment of subclinical lead neurotoxicity. Int Arch Occup Environm Health 1988;61:141-146.

[6] 6. Hermes-Lima M, Pereira B, Bechara JH. Are free radicals involved in lead poisoning ? Review. Xenobiotica 1991;21:1085-1090.

[7] 7. Leonard MH. The solution of lead by synovial fluid. Clin Orthop Rel Res 1969;64:255-261.

[8] 8. Linden MA, Manton WI, Stewart RM, Thai E, Feit H. Lead poisoning from retained bullets: pathogenesis, diagnosis and management. Ann Surg 1982;195:305-313.

[9] 9. Selbst SM, Henretig F, Fee MA, Levy SE, Kitts AW. Lead poisoning in a child with a gunshot wound. Pediatrics 1986;77:413-416.

[10] 10. Wedeen RP, Mallik DK, Batuman V. Detection and treatment of occupational lead nephropathy. Arch Intern Med 1979;139:53-57.

[11] 11. Windebank AJ. Metal neuropathy. In: Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF. Peripheral neuropathy. Ed 3 Philadelphia: Saunders, 1993:1549-1570.

[12] 12. Wu PBJ, Kingery WS, Date ES. An EMG case report of lead neuropathy 19 years after a shotgun injury. Muscle Nerve 1995;18:326-329.