Zusammenfassung
Ein 33-jähriger bislang gesunder Mann wird wegen seit 6 Tagen bestehender starker
diffuser Bauchschmerzen und Obstipation aufgenommen. Beim Patienten besteht kein Fieber,
jedoch eine auffallend blasse Gesichtsfarbe und eine Hypertonie. Im Aufnahmelabor
zeigen sich außer einer mikrozyären Anämie mit einem Hämatokrit von 26 % und einem
mittleren Zellvolumen von 83 fl und einem leicht erhöhten Gesamtbilirubin keine Auffälligkeiten.
Aufgrund der Heftigkeit der Beschwerden wird bereits am Aufnahmetag eine Computertomografie
durchgeführt, welche jedoch ebenso wie Abdomenultraschall, Gastro- und Koloskopie
keinen Hinweis auf die Ursache der Schmerzen ergibt, sodass eine symptomatische Therapie
begonnen wird. Die infolge eingelangten Befunde der Porphyrinausscheidung im Harn
zeigen deutlich gesteigerte Werte, woraufhin die Blutbleikonzentration bestimmt wird,
welche mit 92,3 µg/dl erhöht ist. Im nun mikroskopisch durchgeführten Differenzialblutbild
findet sich eine basophile Tüpfelung von Erythrozyten, im Status zusätzlich ein Gingivableisaum
als typische Zeichen der Bleivergiftung. Therapeutisch wird mit dem Chelatbildner
DMPS in einer Dosis von 1800 mg täglich oral begonnen, worunter es rasch zum Absinken
des Blutbleispiegels kommt und der Patient beschwerdefrei zur Fortführung der Therapie
nach Hause entlassen werden kann.
Abstract
A 33-year-old previously healthy man was admitted to the hospital with a 6-day history
of diffuse abdominal pain and constipation. He was afebrile, looked unwell with a
pale skin and displayed an elevated blood pressure. He had no peritoneal sign, and
bowel sounds were normal. Blood tests were remarkable for a hematocrit of 26 % and
mean cell volume of 83 fl, bilirubin levels were slightly elevated. Abdominal radiographs,
abdominal ultrasound and computed tomography showed stool throughout the colon with
a non-specific bowel gas pattern. Moreover, colonoscopy and gastroscopy provided no
information on the underlying cause of the patient’s severe pain. He was treated with
fluids and spasmolytic drugs until the result of the urinary porphyrin level was received,
which showed an elevated concentration of 1608 µg/d. Consequently, the plasma lead
concentration was determined showing an elevated level of 92.3 µg/d. The examination
of blood slides revealed erythrocytes with basophile stippling. On physical examination,
a bluish discoloration could be seen along the gums. After starting the detoxication
therapy with DMPS – 1800 mg p. o. for the first two days followed by 600 mg DMPS daily
– the complaints disappeared. In spite of an extensive anamnestic exploration the
source of the lead intoxication could not be found until now.
Schlüsselwörter
Bleiintoxikation - Bauchschmerzen - Gingivaverfärbung
Key words
lead intoxication - abdominal pain - discoloration of gums
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Dr. Margot Egger
Interne Abteilung, Konventhospital Barmherzige Brüder
Seilerstätte 2
4020 Linz
Email: margot.egger@gmx.at
