Lead Poisoning Following Soft Tissue Retention of a Lead Pellet: A Case Report

Aim and background: Lead poisoning from retained ballistic fragments is an uncommon and often under-recognized cause of systemic lead toxicity.Most documented cases involve high-velocity bullets, intra-articular or osseous involvement, or fragmentation.This case highlights a rare presentation of lead toxicity resulting from a single, intact, soft tissue-retained lead pellet in the absence of traditional high-risk features.Case description: A 32-year-old woman presented with progressive nausea, vomiting, abdominal pain, headaches, and fatigue approximately 6 weeks after being accidentally shot in the buttock with a lead pellet from an air gun.Initial imaging showed the pellet lodged near the distal femoral neck, posterior to the right hip joint, but without intra-articular penetration, fracture, or fragmentation.Her blood lead level (BLL) was elevated at 6.9 g/dL.Despite the relatively low level and the absence of radiologic features suggestive of joint involvement, her symptoms were consistent with systemic lead toxicity.Conservative management failed, and surgical removal of the fragment was performed.The pellet was found to be extracapsular but near the joint.The patient experienced complete resolution of her systemic symptoms within 1 week of surgery, and follow-up lead levels decreased to 5.4 g/dL.Conclusion: Systemic lead toxicity can occur in the absence of classic risk factors such as intra-articular or osseous involvement.This case emphasizes the importance of clinical suspicion in symptomatic patients with retained lead fragments, even when BLLs are below commonly accepted thresholds.Clinical significance: Clinicians should consider lead toxicity in patients with vague systemic symptoms and retained ballistic fragments, even when BLLs are mildly elevated and no radiographic evidence of joint involvement is present.Prompt surgical removal may be curative even in borderline cases.