A Multidisciplinary Approach to Diagnosis and Management of Adult Plumbism Complicated by Cerebral Herniation: A Case Report

Lead encephalopathy is a rare diagnosis, and its presentation can be challenging to identify and manage. We present a case of a 22-year-old female diagnosed with acute lead encephalopathy. The patient presented to the Emergency Department with a four-month history of non-specific, vague neurological and gastrointestinal complaints. During the initial evaluation, a broad differential diagnosis required inpatient hospitalization for further workup. While hospitalized, the patient developed seizures and encephalopathy followed by cerebral herniation requiring extraventricular drain (EVD) placement and intracranial pressure (ICP) management. Radiopaque material on abdominal radiography and lab work raised concern for possible heavy metal ingestion, specifically lead. Concern arose for intentional spousal poisoning. Treatment with chelation therapy using dimercaptosuccinic acid (DMSA) and British anti-lewisite (BAL) was initiated along with whole bowel irrigation and endoscopic removal of metallic material. After resolution of her critical illness and an additional two rounds of chelation therapy, the patient has regained her baseline health. Managing lead encephalopathy poses significant challenges while concurrently managing elevated ICPs. A patient with severe lead encephalopathy requires collaboration of care across multiple disciplines.