Severe Lead Poisoning in an Opium-Addicted Patient: A Case Report Highlighting Neurological and Hematological Manifestations

Lead poisoning represents a significant yet preventable public health challenge, particularly among populations using adulterated substances. This case report describes a 25-year-old male with a 10-year history of chronic opium use who presented with a constellation of symptoms including progressive weakness, psychiatric manifestations (grandiose delusions and bizarre behavior), anemia, and new-onset tonic-clonic seizures. The patient had been receiving risperidone for psychiatric symptoms for two years prior to admission. Initial laboratory evaluation revealed severe microcytic anemia (Hb 8.6 g/dL) and markedly elevated liver enzymes, while extensive workup ruled out common hematologic, infectious, and autoimmune etiologies. The critical diagnostic finding was an extraordinarily high serum lead level of 1050 μg/dL (normal <5 μg/dL), confirming lead poisoning. Brain MRI demonstrated bilateral globus pallidus hyperintensity, characteristic of lead deposition, and electrodiagnostic studies revealed subacute axonal polyneuropathy. The patient was initiated on D-penicillamine chelation therapy, which resulted in significant improvement of abdominal symptoms and gait abnormalities within one week. This case highlights several clinically relevant points: (1) the potential for lead-adulterated opium to cause severe poisoning, particularly in endemic regions like Iran; (2) the diverse clinical presentation spanning neurological, hematological, and psychiatric domains; and (3) the importance of considering lead toxicity in the differen-tial diagnosis of substance users presenting with unexplained multi-organ dysfunction. The report underscores the need for heightened clinical suspicion of lead poisoning in opium-addicted patients, especially those with neurological or hematological abnormalities. Early serum lead testing and prompt initiation of chelation therapy can prevent irreversible organ damage. Public health measures to reduce opium adulteration and clinician education about this potentially fatal complication are urgently needed in affected regions.