38 year, Male was referred to me for evaluation of pain in abdomen since 1month. He has postprandial heaviness since last three month . For pain abdomen he was seen and evaluated since last one month at different hospitals. He was admitted for this where his Upper G I Scopy, biopsy, H pylori test were normal. CECT abdomen normal .Complete blood profile was done multiple times. PosItive reports were HB 8.9 GM%, ESR 35. Rest of the blood, urine,stool reports are normal. Seen by more experts and they advised colonoscopy and bone marrow examination. Then he came to me for further diagnosis as cause is yet to be found.
So my approach for this patient was pain abdomen ,without signs of localisation with anaemia without blood loss. Further evaluation I found, Serum Iron normal, TIBC low, Ferritin Normal, ESR 40, CRP 20, Absolute reticulocyte 7.5%, Total Bilirubin 1.8, ( Indirect 0.9),LDH 340.
To further narrow it down we were now having additional finding of low TIBC. This lead to DD Of, Chronic lead toxicity, Anaemia of chronic disease, haemoglobinopathy, and other chronic haemolytic anaemic .
Lab results showed -Serum lead 73 MCG /DL ( very high)
We got Cap DMSA ( Succimer ) imported and has started the treatment today. Addition finding in this patient is he is taking AYURVEDIC treatment for infertility ( decreased motility ). Blue gum line -Photo attached .
