Massive diffuse Bauchschmerzen bei einem 33-jährigen bislang gesunden Mann

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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