Claire Panosian Dunavan,
MD, FIDSA, DTM&H (London)
UCLA School of Medicine
Division of Infectious Diseases
10833 Le Conte Ave, CHS 37-121
Los Angeles, CA 90095-1688

Division office: 310-825-7225
Voicemail: 310-794-6053
Facsimile: 310-825-3632

The Lead Files

The Pharos, Fall 2007

Some years ago, at a teaching conference in Long Beach, California, Dr. Mellinkoff discussed the case of a middle-aged Cambodian man who presented to the emergency room with severe episodic abdominal pain. Anyone could tell he was in agony from his facial expression and constant shifting motion. However, his physical examination showed no evidence of peritoneal irritation or bowel obstruction, nor did his radiographs or blood tests suggest any gastric, duodenal, pancreatic, or biliary disorder. Even a porphyria test proved negative.

Then, just as mysteriously as it had begun, the man’s pain resolved, and he left the hospital, only to return weeks later in the same distressed state. This time, however, some of his red cells contained subtle blue inclusions. A bell rang, and a blood specimen was sent for a lead level. When it returned unequivocally high, discussions through a translator finally solved the mystery. Before arriving in the United States, while he was still living in a refugee camp, the patient had been charged with procuring alcohol for use in religious ceremonies. Being an enterprising fellow, he built a still from a car radiator and produced what was needed. Periodically, he also drank the spirits.

Cracking a case of recurrent colic—and then deducing that a soft, blue-white metal leaching from radiator solder into homemade brew was its cause—was no doubt exhilarating to the physicians who first spied basophilic stippling in this religious celebrant’s blood. What doctor would not delight in such a Sherlock Holmesian coup? There’s another moral to the tale, however. The exotic denouement of a clinical-pathologic conference sometimes stands in stark contrast to everyday reality outside hospital lecture halls. Nothing could be truer when considering the ubiquity of lead poisoning from ancient to modern times.

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Claire Panosian Dunavan, MD, DTM&H (London), 2008 President of the American Society of Tropical Medicine and Hygiene, received her education at Stanford University, Northwestern Medical School, Tufts-New England Medical Center, and the London School of Hygiene and Tropical Medicine. First as Chief of Infectious Diseases at LA County-Olive View Medical Center, then as Director of Travel and Tropical Medicine at UCLA, she has been a UCLA professor, clinician, and teacher since 1984. She has also worked overseas in Haiti, Taiwan, the Philippines, Pakistan, Vietnam, Albania, Armenia, and Tanzania, among other countries.

Dunavan’s second career as a print and broadcast journalist includes 6 years as a medical editor, reporter, and co-anchor for Lifetime Television. In 1997, her interview with a dying physician won an international “Freddie” Award. In 2000, with her husband Patrick Dunavan—an 8-time Emmy Award-winning documentary filmmaker —she produced a television program on hepatitis B which has reached 300 million international viewers. In recent years, she has written regularly for national newspapers and magazines. She currently writes a weekly column called “The Infection Files” which runs in California newspapers. Her journalism spans issues in infectious diseases and public health affecting everyone on the planet to global health policy and economics.

© 2010 Claire Panosian Dunavan