Unveiling chronic lead toxicity: A case study on diagnosis, treatment, and recovery

Abstract

This case report presents the diagnostic challenges and successful management of chronic lead toxicity in a 31-year-old female with persistent nonspecific symptoms, including fatigue, cognitive dysfunction, and constitutional complaints. Despite comprehensive prior evaluations showing only mildly elevated inflammatory markers, a definitive diagnosis was achieved through DMSA-provoked urinary lead testing, revealing an approximately 80-fold increase from baseline (1.1 to 85.3 μg/g creatinine). The patient underwent a 3-month DMSA chelation regimen (30 mg/kg/day in 5-day cycles with 9-day intervals), resulting in a significant reduction of provoked lead levels to 11.3 μg/g creatinine and resolution of clinical symptoms. The case highlights three critical aspects of heavy metal toxicity: (1) the limitations of conventional testing in chronic low-level exposure, (2) the diagnostic utility of provoked urinary metal analysis, and (3) the therapeutic efficacy of oral DMSA chelation. This report emphasizes the importance of considering heavy metal toxicity in refractory cases of multisystem complaints and demonstrates the value of protocol-based diagnostic provocation testing in occult exposure scenarios. The favorable outcomes support DMSA as both a diagnostic and therapeutic agent for lead toxicity, suggesting that there should be standardized guidelines for interpreting provoked testing.

How to cite this article

Baydar İ. Unveiling chronic lead toxicity: A case study on diagnosis, treatment, and recovery. J Med Dent Invest 2025;6:e250090. https://doi.org/10.5577/jomdi.e250090