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August 1976

Bullets, Joints, and Lead Intoxication: A Remarkable and Instructive Case

Author Affiliations

From the departments of medicine (Dr Switz) and orthopedics (Drs Elmorshidy and Deyerle), Medical College of Virginia, Virginia Commonwealth University, Richmond, Va.

Arch Intern Med. 1976;136(8):939-941. doi:10.1001/archinte.1976.03630080073022

Synovitis and degenerative arthritis caused by deposition of heavy metal from a local source are not commonly encountered in the medical literature.1 The introduction of metallic bone and joint implants centuries ago led to cases of synovitis and bone destruction caused by reaction to deposition of fine metal particles, but this has become a rarity with progressive improvement in the quality of metallic implants.

This is apparently a rare condition because lead foreign bodies found in man, usually bullets, are readily encapsulated by dense avascular fibrous tissue. Bullets are not a currently documented source of lead poisoning, although the experience is cited in a text by Harrison and co-workers.2

Our patient had a unique case of degenerative arthritis and exacerbation of synovitis with subsequent lead poisoning caused by a bullet in the left ankle region that had remained silent for 40 years.

PATIENT SUMMARY  A 61-year-old teamster was

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