Title : Rare bismuth-induced neurotoxicity case report
Abstract:
Bismuth encephalopathy is a rare cause of neurological dysfunction that can result in confusion, gait disturbances, myoclonus, and dysarthria. Due to the rarity of this condition, a bismuth toxicology workup is usually not immediately initiated upon presentation of neurological symptoms and other causes such as autoimmune or Hashimoto’s encephalopathy are evaluated instead. After gait disturbances and progressive paranoia for a week, this patient was found on the floor at home surrounded by pill vials. Her clinical course in the hospital was marked by tonic-clonic seizure-like episodes, encephalopathy, and persistent altered mental status, ultimately culminating in her death. Evaluations for tricyclic antidepressants overdose, serotonin neurotoxicity, autoimmune encephalitis, and infectious etiologies were non-contributory. Ultimately, the cause of death determined by autopsy was confirmed to be bismuth toxicity, revealing elevated levels of bismuth in the brain, liver, and kidneys. Immunohistochemical testing was negative for prion protein, excluding Creutzfeldt-Jakob Disease, and no other significant pathology was seen in the examination of the body that would have contributed to death. For many years before these events, this patient had been experiencing gastrointestinal symptoms such as bloating, epigastric pain, constipation, and diarrhea. She was lost to follow up in the months leading up to the day she was found down, raising the suspicion that she may have excessively self-administered bismuth-containing medications which are commonly available over the counter for digestive disturbances. Her case emphasizes the necessity of considering bismuth toxicity as a cause for neurological deterioration. Early diagnoses can result in a prompter initiation of treatment which can improve patient outcomes. This account should serve as a reminder for physicians about the critical repercussions of bismuth-containing medications that are frequently used and easily accessible.
