Weight loss, abdominal pain and anemia after a holiday abroad: an unusual cause of lead poisoning

History and admission findings: A 58-year-old woman with type 1 diabetes and coronary artery disease was admitted to hospital because of diminished appetite, weight loss, abdominal pain and anemia. Earlier treatment of duodenal ulcer and cholecystectomy had not achieved sustained relief On physical examination paleness and general weakness was noted. Investigations: Laboratory tests showed a normocytic, normochromic anemia, anisocytosis, polychromasia and basophilic stippling of erythrocytes. Bone marrow examination revealed a hyperreactive erythropoesis with basophilic stippling of erythrocytes and incomplete differentiation of erythroid progenitor cells. Inherited or acquired enzymopathies of erythrocytes were ruled out. Urinary collection showed remarkable elevation of porphyrin concentration. Diagnosis, treatment and course: Suspected poisoning was confirmed by elevated lead concentrations in whole-blood (85,8 mu g/dl) and urine (106,3 mu g/l). A souvenir of Rhodes, a ceramic mug with lead-containing glaze, was identified as the source of the lead poisoning, the lead dissolving into hot tea put in the mug. Treatment with D-penicillamine was begun, and within five weeks anemia disappeared and the patient achieved complete resolution of symptoms. Conclusion: Recognition of the cause of lead poisoning is of critical importance. This case report demonstrates difficulties in diagnosing and identifying the source of poisoning.