RESUMO
A previously healthy 42-year-old woman presented to the emergency department (ED) for arthralgias and painful lesions on her ears, feet, and knee (Figures 1 and 2) that had developed over the last month. She had no significant past medical history and was not taking any prescribed medications. The rash was purpuric with violaceous borders and hemorrhagic bullae. While she had mild pain with movement, her joint examination was otherwise normal and without signs of infection. ED laboratory testing revealed leukopenia (2500/mm(3)) and cocaine metabolites in her urine.
Assuntos
Cocaína/intoxicação , Leucopenia/diagnóstico , Levamisol/intoxicação , Púrpura/diagnóstico , Adulto , Anti-Helmínticos/uso terapêutico , Cocaína/administração & dosagem , Cocaína/urina , Serviço Hospitalar de Emergência , Feminino , Humanos , Imunossupressores/uso terapêutico , Tempo de Internação , Leucopenia/induzido quimicamente , Leucopenia/urina , Levamisol/administração & dosagem , Levamisol/urina , Neutropenia/induzido quimicamente , Neutropenia/diagnóstico , Neutropenia/urina , Dor/tratamento farmacológico , Púrpura/induzido quimicamente , Púrpura/urina , Vasculite/induzido quimicamente , Vasculite/diagnóstico , Vasculite/urinaRESUMO
Dependent on the level of occupational exposure to tetraethyl lead, the occurrence of early signs of toxicity and the urinary excretion of triethyl lead, diethyl lead and total lead compounds were investigated. This was done in the following cohorts in the province of Hubei, China: 277 workers at gasoline depots exposed to gasoline, 36 traffic policemen exposed to automobile exhaust and 342 public office workers (virtually non-exposed controls). Mean external tetraethyl lead exposure concentrations were 84.8 micrograms/m3 (as Pb) for the gasoline depot workers, 5.2 micrograms/m3 for traffic police and 1.1 microgram/m3 for the controls. No significant subclinical indications of organic lead toxicity were found in the group of traffic policemen compared with the controls. In the cohort of gasoline workers, however, there was a statistical increase (vs controls) in the frequency of appearance of tremor and of sinus bradycardia. When the cohort of gasoline workers was divided into subgroups of different ranges of exposure, dose-dependence was noted. In general, the urinary excretion of triethyl lead was very low compared to that of diethyl lead, which appears to be a sensitive and specific indicator of exposure to tetraethyl lead; total lead excretion did not correlate well with actual external tetraethyl lead exposure. On the basis of these data it seems that current occupational exposure limits for tetraethyl lead are inadequate and need to be revised. In addition, a biological limit, based on urinary diethyl lead excretion, may be proposed.