Possível intermediação do sistema imune na polineuropatia periférica plúmbica: relato de caso Possible role of the immune system in lead neuropathy: case report - Elza Dias-Tosta; Adriana Alves; Miriam Calmon; Luiz C. Colombo (Arquivos de Neuro-Psiquiatria)
Relata-se o caso de paciente de 25 anos com ferimento por arma de fogo na articulação coxo-femural esquerda que desenvolveu, entre outros sinais de intoxicação plúmbica, polineuropatia periférica axonal predominantemente motora. Tratado inicialmente com corticosteróides em doses imunossupressoras obteve melhora, mas apresentava recidiva a cada tentativa de retirada da medicação. Demonstrados laboratorialmente níveis séricos tóxicos de chumbo, foi submetido à quelação com EDTA e à retirada cirúrgica do projétil, com boa recuperação da polineuropatia, sem necessidade ulterior de corticosteróides. Enfatiza-se: 1) o possível papel do sistema imune na fisiopatogenia da intoxicação por chumbo, podendo ser um dos motivos das diferentes apresentações clínicas das neuropatias plúmbicas na infância e no adulto; 2) a importância da retirada do material plúmbeo quando alojado em articulações. This is a case report of a twenty-five years old man who developed, due to lead intoxication, a severe axonal peripheral predominantly motor neuropathy, after a shotgun injury. The projectile was retained in the right hip. Before this diagnosis had been done he was treated with corticosteroids in immunosuppressive doses and showed an improvement, but he had worsened at each attempt to interrupt the drug. Because he had also other signs of lead intoxication, such as abdominal cramps, severe anemia and seizures it was search for the blood levels of lead that was 101.2 }μg/dl. The patient was treated with calcium disodium edetate and surgical removal of lead fragments. After that he had a good outcome with no need of corticosteroids. It is emphasized the possible relevance of the immune system on the mechanism of plumbic intoxication and the importance of the withdrawal of the lead material retained in joints.