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A chasing dead-end case report: a fatal lead intoxication following an attempted homicide

  • Benedicte LelievreEmail author
  • Stephane Triau
  • Philippe Codron
  • Yoran Mariau
  • Frederique Papin-Lefebvre
  • Alexandre Collin
  • Guillaume Drevin
  • Gael Le Roux
  • Marie Briet
  • David Boels
  • Franck Letournel
Case Report

Abstract

Purpose

In developed countries, lead intoxication is decreasing in adults as sources of contamination were considerably reduced. Hence, cases of lead encephalopathy have become scarcer. We report the case of a 50-year-old woman who developed a systemic intoxication due the persistence of lead fragments in her abdomen and back. The patient was shot with homemade gun bullets, which were immediately surgically removed. During the eight following months, she presented progressive worsening signs of systemic and cerebral lead intoxication. On admission to hospital, her blood lead concentration was of 1650 µg/L. Despite surgeries and the use of lead chelators, she died 8 days later.

Methods

Organs were harvested during postmortem autopsy for pathological investigations, and cerebral lead concentration was determined using inductively coupled plasma–mass spectrometry.

Results

Lead encephalopathy was confirmed based on elevated lead concentration measured in brain (3.04 µg/g in cortex and 2.70 µg/g in nucleus lentiformis). Furthermore, neuropathological examination highlighted a strong blood brain barrier (BBB) disruption.

Conclusions

Based on this fatal lead intoxication case, it appears that BBB leakage is a major pathological sign of lead encephalopathy and that lead titration in formalin-fixed brain tissue is a valuable tool for diagnosis.

Keywords

Lead Encephalopathy Homicide Homemade bullets Blood brain barrier 

Notes

Compliance with ethical standards

Conflict of interest

There are no financial, or other, relations that could lead to a conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals that were performed by any of the authors.

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Copyright information

© Japanese Association of Forensic Toxicology 2020

Authors and Affiliations

  • Benedicte Lelievre
    • 1
    • 2
    Email author
  • Stephane Triau
    • 3
  • Philippe Codron
    • 4
  • Yoran Mariau
    • 5
  • Frederique Papin-Lefebvre
    • 5
  • Alexandre Collin
    • 3
  • Guillaume Drevin
    • 1
  • Gael Le Roux
    • 6
  • Marie Briet
    • 1
  • David Boels
    • 6
  • Franck Letournel
    • 7
  1. 1.Pharmacology- Toxicology LaboratoryCHUAngersFrance
  2. 2.Groupe d’Etude des Interactions Hôte-Pathogène (GEIHP EA3142) SFR ICAT 4208UNIV Angers, UNIV BrestAngersFrance
  3. 3.Anatomic Pathology LaboratoryCHUAngersFrance
  4. 4.Neurology UnitCHUAngersFrance
  5. 5.Legal Medicine InstituteCHUCaenFrance
  6. 6.Poison Control Center-Toxicovigilance UnitCHUAngersFrance
  7. 7.Neurobiology-Neuropathology LaboratoryCHUAngersFrance

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