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

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 mu g/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 mu g/g in cortex and 2.70 mu g/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.