Abstract
Purpose
In developed countries, lead intoxication is decreasing in adults as sources of contamination were considerably reduced. Hence, cases of lead encephalopathy have become scarcer. We report the case of a 50-year-old woman who developed a systemic intoxication due the persistence of lead fragments in her abdomen and back. The patient was shot with homemade gun bullets, which were immediately surgically removed. During the eight following months, she presented progressive worsening signs of systemic and cerebral lead intoxication. On admission to hospital, her blood lead concentration was of 1650 µg/L. Despite surgeries and the use of lead chelators, she died 8 days later.
Methods
Organs were harvested during postmortem autopsy for pathological investigations, and cerebral lead concentration was determined using inductively coupled plasma–mass spectrometry.
Results
Lead encephalopathy was confirmed based on elevated lead concentration measured in brain (3.04 µg/g in cortex and 2.70 µg/g in nucleus lentiformis). Furthermore, neuropathological examination highlighted a strong blood brain barrier (BBB) disruption.
Conclusions
Based on this fatal lead intoxication case, it appears that BBB leakage is a major pathological sign of lead encephalopathy and that lead titration in formalin-fixed brain tissue is a valuable tool for diagnosis.
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14 October 2022
A Correction to this paper has been published: https://doi.org/10.1007/s11419-022-00647-5
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The case selected for this work underwent medicolegal autopsy directed by judicial authorities. The publication of this article was authorized by a judge, and the manuscript was submitted after the end of the court proceeding. For the control sample, the national register for opposition was consulted and there was no opposition. Moreover, the control samples are stored in the center for biological resources at the corresponding author's affiliated hospital, as required by the French legislation.
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Lelievre, B., Triau, S., Codron, P. et al. A chasing dead-end case report: a fatal lead intoxication following an attempted homicide. Forensic Toxicol 38, 505–510 (2020). https://doi.org/10.1007/s11419-019-00519-5
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DOI: https://doi.org/10.1007/s11419-019-00519-5