ABSTRACT
We describe the case of a 40-year old Iranian man who was admitted to our hospital with severe abdominal pain, abnormal liver function tests and normocytic anemia. Suffering from multiple sclerosis, he was a regular user of opium for pain relief. Basophilic stippling of erythrocytes pointed towards the diagnosis of lead intoxication, the most likely source being contaminated Iranian opium. Serum lead and zinc protoporphyrin levels were strongly elevated. To assess the hepatotoxic effects of lead poisoning a liver biopsy was performed. Pathomorphologic findings of hepatotoxicity, rarely reported in humans, included active hepatitis together with extensive microvesicular and macrovesicular steatosis, hemosiderosis and cholestasis, and a lymphocytic cholangitis. Whilst treated with chelating therapy, liver enzymes returned to normal, suggesting reversibility of the histological findings.
Subject(s)
Lead Poisoning/pathology , Liver/pathology , Opioid-Related Disorders , Opium , Abdominal Pain/etiology , Adult , Anemia/etiology , Anemia/pathology , Chelating Agents/therapeutic use , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/pathology , Cholangitis/etiology , Cholangitis/pathology , Drug Contamination , Fatty Liver/etiology , Fatty Liver/pathology , Hemosiderosis/etiology , Hemosiderosis/pathology , Humans , Lead/blood , Lead Poisoning/drug therapy , Lead Poisoning/etiology , Liver/drug effects , Male , Protoporphyrins/blood , Treatment OutcomeABSTRACT
The present necropsy study shows an oriental pattern of gallstone disease in Singapore, namely, a relatively low overall frequency, an equal involvement of both sexes, a high proportion of pigment stones, and the common occurrence of choledocholithiasis associated with pyogenic cholangitis. There is a close association between opium addiction and cholelithiasis in the adult male Chinese in Singapore, and the long-term abuse of opium may be an important aetiological factor in the pathogenesis of oriental cholelithiasis.