Encephalopathy from lead poisoning masquerading as a flu-like syndrome in an autistic child
Abstract
Acute encephalopathy from childhood lead poisoning is fortunately rare. However, in pediatric patients with developmental disabilities and pica, there is a risk of lead exposure at a dose commensurate with encephalopathy, coupled with a risk of delayed diagnosis because of difficulty in distinguishing between baseline and altered behavior. We report here a 4-year old autistic boy who presented to the pediatrician's office with gastrointestinal symptoms and behavioral changes and was at first thought to have a viral syndrome. He returned 2 days later with a worsening illness; increasing pallor, vomiting, abdominal colic, and changes in consciousness were recognized in the emergency department as lead-induced anemia and encephalopathy, associated with a positive abdominal film for paint chips and a blood lead level equal to 216 microg/dL (10.43 micromol/L) (reference, <10 microg/dL or 0.483 micromol/L). As this case illustrates, prompt recognition is dependent on the skills and suspicions of an astute clinician, especially in the busy emergency department.
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Pica is associated with dangerous outcomes including elevated blood lead levels, bezoars, obstructions, perforation and poisoning.
“In some cases pica is associated with dangerous outcomes, including elevated blood lead levels, bezoars, obstructions, perforation and poisoning”
From Gastrointestinal Issues and Autism Spectrum Disorder (2020) · cites this paper as [23]
Cites
Lead Exposure in Children: Prevention, Detection, and Management
(2005) · PEDIATRICS · doi:10.1542/peds.2005-1947 · Cited by 277 · see citing works
Interactions between iron deficiency and lead poisoning: epidemiology and pathogenesis
Kwong, W. H. P., FRIELLO, P., & Semba, R. D. (2004) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2004.03.017 · Cited by 185 · see citing works
Undue Absorption of Lead among Children — A New Look at an Old Problem
Lin-Fu, J. S. (1972) · New England Journal of Medicine · doi:10.1056/nejm197203302861306 · Cited by 158 · see citing works
Update on the Clinical Management of Childhood Lead Poisoning
Woolf, A. D., Goldman, R. H., & Bellinger, D. C. (2007) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2007.01.008 · Cited by 145 · see citing works
Self-citationAssociation between iron deficiency and low-level lead poisoning in an urban primary care clinic.
Wright, R. O., Shannon, M. W., Wright, R. J., & Hu, H. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.7.1049 · Cited by 104 · see citing works
Lead Intoxication in Children with Pervasive Developmental Disorders
Shannon, M. W., & Graef, J. W. (1996) · Journal of Toxicology Clinical Toxicology · doi:10.3109/15563659609013767 · Cited by 71 · see citing works
Lead Poisoning and Recurrent Abdominal Pain
Shiri, R., ANSARI, M., RANTA, M., et al. (2007) · Industrial Health · doi:10.2486/indhealth.45.494 · Cited by 47 · see citing works
The radiologic "lead band" revisited
Blickman, J. G., Rh, W., & Graef, J. (1986) · American Journal of Roentgenology · doi:10.2214/ajr.146.2.245 · Cited by 41 · see citing works
Accardo, P., Whitman, B. Y., Caul, J., & Rolfe, U. T. (1988) · Clinical Pediatrics · doi:10.1177/000992288802700108 · Cited by 39 · see citing works
Gordon, R. A., Roberts, G., Amin, Z., et al. (1998) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.152.11.1100 · Cited by 31 · see citing works
The Dense Metaphyseal Band Sign
RABER, S. A. (1999) · Radiology · doi:10.1148/radiology.211.3.r99jn13773 · Cited by 23 · see citing works
Metaphyseal abnormalities in children: pathophysiology and radiologic appearance.
Laor, T., & Jaramillo, D. (1993) · American Journal of Roentgenology · doi:10.2214/ajr.161.5.8273604 · Cited by 21 · see citing works
Pain in abdomen--do not forget lead poisoning.
Sood, A., Midha, V., & Sood, N. (2003) · PubMed · Cited by 19 · see citing works
Elevated blood lead levels in children are associated with lower erythropoietin concentrations
Liebelt, E. L., Schonfeld, D. J., & Gallagher, P. (1999) · The Journal of Pediatrics · doi:10.1016/s0022-3476(99)70381-1 · Cited by 16 · see citing works
Dense metaphyseal bands in patients on long term parenteral nutrition
Diament, M., Kangarloo, H., Kodroff, M. B., et al. (1981) · Pediatric Radiology · doi:10.1007/bf00972052 · Cited by 3 · see citing works
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Gastrointestinal Issues and Autism Spectrum Disorder
Madra, M., Ringel, R., & Margolis, K. G. (2020) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2020.02.005 · Cited by 159 · see citing works
- Authors
- George, M., Heeney, M. M., & Woolf, A. D.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- George, Mathew
- Venue
- Pediatric Emergency Care
- Published
- 2010-05
- Volume
- 26
- Issue
- 5
- Pages
- 370-373
- ISSN
- 0749-5161 (ISSN-L)
- OpenAlex
- W2069687332
- Cited by
- 19
- References
- 15
- Citations by year
- 2026: 1 · 2023: 1 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 3 · 2014: 2 · 2013: 1 · 2012: 3
- FWCI
- 1.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Emergency Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K12HL087164)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Heavy Metal Exposure and Toxicity
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Health Sciences › Medicine › Surgery › Medical Case Reports and Studies
- Keywords
- lead poisoning, acute encephalopathy, autism spectrum disorder, pica, paint chips, blood lead levels, developmental disabilities, pediatric emergency diagnosis
- MeSH terms
- Autistic Disorder, Chelating Agents, Child, Preschool, Diagnosis, Differential, Follow-Up Studies, Humans, Influenza, Human, Male, Intensive Care Units, Pediatric, Chelation Therapy, Lead Poisoning, Nervous System, Childhood
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