Differentials
Iron deficiency anemia
SIGNS / SYMPTOMS
Anemia is rare with lead poisoning, except for high-level exposure.
Iron deficiency is usually related to dietary deficiency or blood loss. Responds to iron supplementation with correction of anemia.
INVESTIGATIONS
Iron store measured by serum iron, iron-binding capacity, transferrin, ferritin, or bone marrow indicates iron deficiency.
Non-lead peripheral neuropathy
SIGNS / SYMPTOMS
No history of lead exposure.
Faster rates of symptom progression.
INVESTIGATIONS
Low blood lead level.
Blood/urine testing may reveal other toxicants.
Appropriate cultures and serology reveal infectious causes.
Positive immune markers for chronic inflammatory and immune diseases.
Characteristic nerve conduction study/electromyography findings for neurologic syndromes.
Arsenic poisoning
SIGNS / SYMPTOMS
May have neuropathy with skin lesions, including keratoses.
May have history of exposure to arsenic.
INVESTIGATIONS
Hair arsenic.
24-hour urine collection for arsenic during chelation therapy.
Encephalitis
SIGNS / SYMPTOMS
No history of lead exposure.
May have history of exposure to nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, antivirals, immunomodulators, or anticonvulsants.
Lead encephalopathy often has prominent cerebellar signs, depressed sensorium, and seizures.
INVESTIGATIONS
Low blood lead level.
Detection of Plasmodium in peripheral blood smear or detection of bacterial and viral infections in blood, throat, and sputum cultures.
CT/MRI scanning reveals characteristic findings of the underlying cause.
Analysis and culture of cerebrospinal fluid reveals characteristic findings, infections, and infection- or paraneoplastic-related antibodies.
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