RESUMO
BACKGROUND: In most industrialized countries, occupational lead poisoning has become increasingly rare, however this metal remains a serious health hazard in the rest of the world. REPORT OF CASES: We observedfour male patients (aged 35 / 54 years) who had suffered recurrent abdominal pain due to recent lead exposure (for 7 to 13 months) in two Chinese battery recycling plants. On their return to Italy, three of them presented normocytic, normochromic anaemia. The diagnosis was confirmed by high lead levels in the blood and urine, decreased erythrocyte delta-aminolevulinic acid dehydratase (ALA-D), raised erythrocyte zinc protoporphyrin (ZP), and elevated urinary excretion of b-aminolevulinic acid (ALA-U) and porphyrins. Chelation with EDTA resulted in increased urinary lead excretion, improvement of the clinical picture, decreased ZP, and progressive normalization of the other lead biomarkers (Pb-B, ALA-D, ALA-U, urinary porphyrins). CONCLUSIONS: Temporary work in developing countries may result in imported lead poisoning. Differential diagnosis of this unusual condition requires careful medical history collection and specific toxicological analysis. Preventive measures for workers going abroad are needed.
Assuntos
Intoxicação por Chumbo/diagnóstico , Intoxicação por Chumbo/prevenção & controle , Doenças Profissionais/diagnóstico , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/prevenção & controle , Dor Abdominal/induzido quimicamente , Adulto , Ácido Aminolevulínico/sangue , Ácido Aminolevulínico/urina , Anemia/induzido quimicamente , Biomarcadores/sangue , Biomarcadores/urina , Quelantes/uso terapêutico , Terapia por Quelação/métodos , China , Países em Desenvolvimento , Diagnóstico Diferencial , Ácido Edético/uso terapêutico , Humanos , Itália , Chumbo/sangue , Chumbo/urina , Intoxicação por Chumbo/sangue , Intoxicação por Chumbo/tratamento farmacológico , Intoxicação por Chumbo/urina , Masculino , Anamnese , Metalurgia , Pessoa de Meia-Idade , Doenças Profissionais/sangue , Doenças Profissionais/tratamento farmacológico , Doenças Profissionais/urina , Exposição Ocupacional/efeitos adversos , Protoporfirinas/sangue , Protoporfirinas/urina , Reciclagem , Resultado do TratamentoRESUMO
Erythropoietic protoporphyria is a rare photodermatosis for which treatment options are limited. The present report describes the clinical features of a patient with erythropoietic protoporphyria and liver function test abnormalities associated with treatment with beta-carotene. Subsequent treatment with narrow-band UVB phototherapy resulted in marked subjective improvement in photosensitivity, which was confirmed by abolition of demonstrated abnormalities on monochromator phototesting. The therapeutic options for photosensitivity in erythropoietic protoporphyria are reviewed and discussed.