case report
Behavioral change and weight loss looked psychiatric. Lead poisoning from a ceramic jug did not.
2026-06-23
Behavioral change and weight loss looked psychiatric. Lead poisoning from a ceramic jug did not.
A sudden decline
A 28-year-old previously healthy man presented with a one-week history of worsening diffuse abdominal pain. Along with the physical pain, he was suffering from anorexia and a sudden difficulty sleeping. Initial investigations showed signs of liver stress, with an elevated ALT of 242 U/L and total bilirubin of 5.3 mg/dL. An abdominal ultrasound was normal, and he was discharged.
Escalating symptoms and a partial label
One week later, the man’s condition deteriorated. He presented to a second hospital with severe abdominal pain and jaundice. His physical examination showed yellowing of the eyes (scleral icterus) and diffuse abdominal tenderness. Laboratory tests showed persistent liver elevation and a hemoglobin of 12.2 g/dL. Following an endoscopy, he was diagnosed with celiac disease and Gilbert’s syndrome. He was placed on a gluten-free diet and his pain initially subsided over the following 11 days.
The recurrence
Two weeks after discharge, the patient arrived at a third hospital. Despite following the gluten-free diet, his acute abdominal pain and jaundice had returned. He had lost 12 kilograms—about 26 pounds—in just four weeks. He was now suffering from constipation and continued sleep disturbance. His total bilirubin had risen even higher, to 7.5 mg/dL. He was undergoing an extensive diagnostic work-up for everything from porphyria to C1 esterase deficiency, with no clear results.
The ceramic jug
The breakthrough came during a review of his social and personal history. Two months earlier, the man had purchased a ceramic jug from Greece and had been using it to drink water every single day. The inside of the jug showed erosions of the inner surface. When the jug was tested with a home lead kit, it was positive. Lead glazes, if improperly formulated, can allow toxic amounts of lead to migrate into food or water. Following this discovery, a blood lead level was finally ordered.
The definitive finding
The patient’s lead level was markedly elevated at 89 µg/dL, significantly higher than the reference range of 0–5 µg/dL. This finding recontextualized his months of suffering. Lead poisoning is known to cause a spectrum of non-specific symptoms, including the colicky abdominal pain he experienced, as well as sleep disturbance, irritability, fatigue, and confusion. Because his exposure was acute—lasting only two to three months—he did not show the classic chronic sign of basophilic stippling in his blood cells.
Recovery through chelation
The patient was diagnosed with acute lead poisoning and began oral chelation therapy with dimercaptosuccinic acid (DMSA). He followed a regimen of 30 mg/kg/day for five days, followed by 20 mg/kg/day for 14 days. On follow-up, the treatment proved successful: his blood lead levels dropped to 23 µg/dL, and he showed substantial clinical and biochemical improvement.
The medical picture
Lead level
89 µg/dL
Alanine aminotransferase (ALT)
242 U/L
Total bilirubin
5.3 mg/dL to 7.5 mg/dL
Anti-tissue transglutaminase antibody (anti-IgA tTG and IgG tTG)
192 IU/mL
Hemoglobin
11.7 g/dL
Adapted faithfully from the open-access case report: ACG Case Reports Journal (PMC4748209). DOI: 10.14309/crj.2016.27. Read the original at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748209/.