Gastroenterology Today Summer 2021

CASE REPORT
HEAVY METAL IN THE
GASTROENTEROLOGY CLINIC
Massardi C, Cooney J, Poullis A, Department of Gastroenterology, St George’s Hospital, London
Case Study
A 29-year-old male had attended the Emergency Department
on several occasions over the previous month with worsening
abdominal pain, constipation, nausea and vomiting. He had
no past medical or surgical history and worked as a builder
and decorator. There was no significant smoking or alcohol
history and he had no known family history of gastrointestinal
disease. Clinical examination was unremarkable. No cause
had been found for his symptoms so he was referred to the
Gastroenterology outpatient clinic.
Routine blood tests showed deranged liver function tests (LFTs), with
elevated bilirubin (31 umol/L) alanine transaminase (192 units/L) and
gamma-glutamyl transferase (65 iU/L) Autoimmune and viral liver
screens were negative. Ultrasound of the liver was normal apart from
some hyperechogeneity in the liver in keeping with fatty infiltration.
An abdominal radiograph was performed which found small specks
of high attenuation material in the colon [Figure 1]. A porphyria
screen was arranged due to the unclear aetiology of the patient’s
symptoms and blood tests.
The patient’s urine porphyria screen was found to be abnormal, with
a porphyrin/creatinine ratio of 472 nmol/mmol creatinine, therefore
further porphyria assays were requested.
GASTROENTEROLOGY TODAY - SUMMER 2021
These demonstrated a porphobilinogen of 27.8 umol/L (normal
limit