{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:18:08Z","timestamp":1762867088404,"version":"3.40.4"},"reference-count":28,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,2,1]]},"abstract":"<jats:p>A man aged 30\u2005years presented to an emergency department with a 1\u2005month history of severe abdominal pain, jaundice, constipation, lower extremity weakness and weight loss. A peripheral blood smear was performed that showed basophilic stippling of erythrocytes prompting a blood lead level (BLL) evaluation. The patient had a BLL of &gt;200\u2005\u00b5g\/dL. Retained bullet fragments were identified in the left lower extremity from a previous gunshot wound 10\u2005years prior. Lead from the excised bullet fragment was consistent with the patient's blood lead by isotope ratio analysis. This case is a rare example of a severely elevated BLL attributed to bullet fragments in soft tissue. Bullets retained in soft tissue are not often considered a risk factor for a markedly elevated BLL because they become encapsulated within the tissue over time.<\/jats:p>","DOI":"10.1136\/bcr-2016-217351","type":"journal-article","created":{"date-parts":[[2017,3,8]],"date-time":"2017-03-08T16:00:16Z","timestamp":1488988816000},"page":"bcr2016217351","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Severe lead toxicity attributed to bullet fragments retained in soft tissue"],"prefix":"10.1136","volume":"2017","author":[{"given":"Debora","family":"Weiss","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Don","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Feldman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate E","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,3,8]]},"reference":[{"issue":"(SS-02)","key":"2025042705350748000_2017.mar08_2.bcr2016217351.1","first-page":"1","article-title":"Surveillance for fatal and nonfatal firearm-related injuries\u2014United States, 1993\u20141998","volume":"50","author":"Gotsch","year":"2001","journal-title":"MMWR Surveill Summ"},{"key":"2025042705350748000_2017.mar08_2.bcr2016217351.2","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1097\/00005373-200105000-00020","article-title":"The effects of retained lead bullets on body lead burden","volume":"50","author":"McQuirter","year":"2001","journal-title":"J Trauma"},{"key":"2025042705350748000_2017.mar08_2.bcr2016217351.3","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh074"},{"key":"2025042705350748000_2017.mar08_2.bcr2016217351.4","unstructured":"U.S. Department of Housing and Urban Development (HUD) [internet]. 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