ABSTRACT
Infiltrative cardiomyopathies are an increasingly recognized cause of heart failure warranting systematic evaluation. Given overlap of clinical and imaging findings among etiologies of infiltrative cardiomyopathies, comprehensive evaluation, including a history and physical examination, advanced cardiac imaging, and sometimes endomyocardial biopsy, is required for diagnosis. We report a case of infiltrative cardiomyopathy in which endomyocardial biopsy confirmed diagnosis of cobalt-induced cardiomyopathy. The novel teaching points highlighted by this case report include identification of heavy-metal toxicity as a cause of infiltrative cardiomyopathy, and the outline of a diagnostic approach and management for cobalt-induced cardiomyopathy.
Le fait que les cardiomyopathies infiltrantes sont de plus en plus reconnues comme la cause de l'insuffisance cardiaque justifie une évaluation systématique. Puisque les résultats cliniques et d'imagerie se recoupent entre les étiologies des cardiomyopathies infiltrantes, l'évaluation exhaustive, y compris les antécédents et l'examen physique, les techniques avancées en imagerie cardiaque et parfois la biopsie endomyocardique, est nécessaire au diagnostic. Nous présentons un cas de cardiomyopathie infiltrante pour lequel la biopsie endomyocardique a permis de confirmer le diagnostic d'une cardiomyopathie induite par le cobalt. Parmi les points à enseigner illustrés dans cette observation, on cite la reconnaissance de la toxicité des métaux lourds comme une cause de cardiomyopathie infiltrante, et la vue d'ensemble de l'approche diagnostique et de la prise en charge de la cardiomyopathie induite par le cobalt.
ABSTRACT
Lead toxicity in adults is characterized by nonspecific symptoms of abdominal pain, vomiting, constipation, fatigue, and weight loss. We present a case of severe lead toxicity that developed subacutely, causing quadriparesis 9 years after a gunshot wound with retained bullet fragments. The onset of symptoms may have been related to the development of a pseudocyst. The long interval between the gunshot wound and the onset of symptoms contributed to a delay in suspecting that the retained bullet was a source of lead toxicity. The patient's symptoms gradually improved after chelation therapy, removal of the bullet fragment, and an extended program of acute inpatient rehabilitation. LEVEL OF EVIDENCE: V.
Subject(s)
Foreign Bodies/surgery , Lead Poisoning/etiology , Quadriplegia/etiology , Wounds, Gunshot/complications , Adult , Chelation Therapy/methods , Femur/surgery , Follow-Up Studies , Humans , Lead Poisoning/physiopathology , Male , Quadriplegia/physiopathology , Quadriplegia/therapy , Rare Diseases , Severity of Illness Index , Time FactorsABSTRACT
This report describes 2 cases of metallosis from metal-on-polyethylene total hip replacements. Case 1 involved a Stryker rejuvenate implant, which has since been recalled. This patient had minimal symptoms, an elevated cobalt level, and loosening. The patient in case 2 had a Dupuys Pinnacle system, with symptoms of weakness, rash, and hip pain. Abnormal laboratory values include elevated sedimentation rate, C-reactive protein, creatinine, cobalt, and decreased hematocrit. Magnetic resonance imaging revealed synovial thickening and extracapsular edema. Although metallosis is a well-established complication of metal-on-metal implants, emerging data reveal that it also may be a problem in non-metal-on-metal implants such as either metal-on-polyethylene or ceramic-on-polyethylene implants, perhaps related to modular corrosion.
