LAUSR

https://jkms.org In November 2018, a 50-year-old man has received emergency room and gastrointestinal medical care several times due to severe abdominal pain and 11-kilogram weight loss that occurred 3 months ago. Various tests were performed, but no cause of severe periumbilical abdominal pain was found (abdominal computed tomography, ultrasonography, upper gastrointestinal endoscopy, and colonoscopy). Blood tests showed microcytic hypochromic anemia (hemoglobin, 8.7 g/dL; red blood cell, 3.31 × 106/mm3; hematocrit, 27.9%). And basophilic stippling teardrop of red blood cells was observed in the peripheral blood smear (Fig. 1). After several interviews, the patient revealed that he had been taking traditional herbal medicine for about half a year. He bought the ingredients for the herbal medicine himself at various traditional markets and made and took them himself. The worse the patient got, the harder he took the herbal medicine. Tests were conducted on heavy metals, and the blood lead level was 164 μg/dL (adult normal limit, 10 μg/dL).1,2 The cause of severe periumbilical abdominal pain was lead colic.3 Other heavy metals test results were within normal limits (urine mercury, 2.252 μg/L; blood mercury, 1.495 μg/L; urine cadmium, 1.58 μg/g creatinine; blood cadmium, 0.95 μg/L; urine nickel, 3.67 μg/L; blood manganese, 4.37 μg/L; urine arsenic, 107.016 μg/L; blood zinc, 75 μg/dL; blood copper, 95 μg/dL). He was hospitalized 16 days and had chelation treatment (dimercaptosuccinic acid 600 mg twice a day for 14 days).4,5 After a month, the blood lead level fell to 75.2 μg/dL and was able to return J Korean Med Sci. 2019 Dec 30;34(50):e320 https://doi.org/10.3346/jkms.2019.34.e320 eISSN 1598-6357·pISSN 1011-8934