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Massive lead poisoning from a gunshot with high soft lead charge.
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Edité par CCSD -
International audience. Objective:To report a case of unusually rapid onset of lead poisoning after a special ammunition gunshot.Case report:A 38-year-old man with no history of lead poisoning was shot. The bullet blew through a door before reachingthe victim, fragmented, and resulted in a riddling of 60 secondaryprojectiles in the victim. Initial lesions mainly concerned the left chest, left shoulder, and left brachial plexus. The first blood lead level (BLL) was collected on day 7 after the wound and analysed by graphite furnace atomic absorption spectrometry. BLL was1048 μg/L (French reference value in exposed adult men < 200 μg/L), with a peak to 1566 μg/L on day 11. Symptomatology was a sensation of extreme fatigue, constipation, and peripheral neurologic involvement of the left ulnar. Other markers on day 11 were slight anemia (hemoglobin 11.6 g/dL), erythrocyte protoporphyrin level (1.911 μmol/L) and urine delta-aminolevulinic acid (13 μmol/mmol of creatinine). Two subcutaneous metallic residues and a hair sample were sent for analysis by inductively coupled plasma mass spectrometry to confirm the presence oflead; they confirmed that lead was present in the residues (817 and 841 mg per gram), there was a recent incorporation of lead in hair (63 ng/mg in the end and 119 ng/mg in the basis), and the lead in the hair was from the same origin as the bullet (isotopic ratios were the same Pb 206/Pb 207 ¼1.17, Pb 208/Pb 207 ¼ 2.44, Pb 208/Pb 206 ¼ 2.08). Several chelation treatments with succimer and sodium calcium edetate together with surgicalextraction of lead fragments did not prevent clinical and biological signs of chronic lead poisoning.Conclusion:This special ammunition contained 30 g inert soft lead not protected with a metallic envelope. It is not intended to be used directly on living argets. Such a rapid, high, and massive contamination is linked to a pure and important lead charge of the cartridge not protected by a metallic envelope, the presence of “soft lead, which is more prone to fragmentation than hard lead ”, and the location of the lead fragments in the body, especially in the pleura and near the shoulder joint. The presence of a substantial lead store in the body is now responsible for chronic lead poisoning, probably for the rest of the patient ’s life.
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