Lead encephalopathy mimicking as acute encephalitis syndrome in a child

Lead encephalopathy is a rare but life-threatening neurotoxic emergency in children. Although rare, lead encephalopathy can mimic infectious encephalitis leading to delay in diagnosis and management in resource-limited settings. A toddler belonging to poor socioeconomic strata presented with non-bilious vomiting for 6 days, intermittent fever for 3 days, seizures and rapidly deteriorating neurological status a few hours prior to arrival in triage. A thorough history later found the child’s visits to a battery recycling unit. Blood lead levels (BLL) were 88.1 mcg/dL. Chelation therapy with intramuscular dimercaprol (British anti-Lewisite) along with calcium disodium EDTA was administered via intramuscular injection for 5 days but the child deteriorated due to severe brain herniation, resulting in demise. In cases of unexplained encephalopathy in children (after ruling out infectious causes) along with the presence of environmental and occupational risk factors with biochemical support, lead toxicity must be considered early. Early targeted history taking and chelation are essential to prevent irreversible damage.