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Hidden Giant: Medium Vessel Vasculitis as a Cause for Unresolving Fever

Samples of meat from the patient's freezer were analyzed by x-ray study to determine the presence of metal fragments. Two packages of ground deer meat (UL and UR) and one package of ground goat (LL) revealed a number of large metal fragments (black arrows) throughout the meat (Panel A). Each package of meat was approximately 1 kg. Upon further examination at higher resolution it became clear that there were smaller metal fragments throughout the samples (orange arrows). When selecting bullets, hunters have a choice of materials. Three of the common options are lead bullets, lead-core copper-jacketed bullets, or lead-free bullets (Panel B). All bullets shown are 165-grain, 30-caliber rifle bullets. Importantly, hunters may confuse the copper-jacketed lead bullets with bullets that are lead free, as they have a copper jacket covering most of the lead core.

The purpose of this article is to determine if conversion from eating wild game harvested with lead-based ammunition to nonlead-based ammunition results in lower blood lead levels. Supersonic injection of toxin-leeching frangible projectiles into food is intuitively bad. As much as 95% of the ~13.7 million hunters in the United States choose shrapnel-inducing lead bullets to kill game; in addition, not harvesting meat is an incarcerable crime. A lead ammunition ban on certain federal lands was recently rescinded and the National Rifle Association refutes any risk from eating lead bullet-harvested game.

Methods

A patient subsisting solely on lead-shot meat was converted to non-lead ammunition and his blood lead level tracked. Concomitant with his conversion to nonlead ammunition, a controlled experiment was performed using the patient’s bullets to determine his daily lead intake from lead-shot meat.

Results

While eating lead-shot meat, the patient was consuming 259.3 ± 235.6 µg of lead daily and his blood lead level was 74.7 µg/dL. Conversion to nonlead ammunition was associated with a reduced blood lead level.

Conclusions

Unsafe blood lead levels can occur from eating game harvested with lead ammunition. Physicians should warn hunting patients of this potential risk and counsel them about the availability of nonlead ammunition alternatives.

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-Eric J. Buenz, PhD, Gareth J. Parry, MB, ChB, FRACP

This article originally appeared in the May issue  of The American Journal of Medicine.

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