A Unique Case of Lead-Paint Pica in a 14-Year-Old Girl

Abstract

Background: Pica, as defined by the DSM-V, is the persistent consumption of non-nutritive, non-food substances for at least one month, which cannot be explained by developmental stage or cultural norms. While commonly associated with developmental disorders, pregnancy, and iron deficiency, pica can result in serious medical complications, particularly when toxic substances are ingested. Aims: This study describes a unique case of pica and elucidate the importance of early recognition and management in order to avoid long-term complications. Case Description: Here we present a rare case of a 14-year-old female with no significant past medical or psychiatric history who developed lead poisoning secondary to chronic ingestion of lead-based paint. The patient was hospitalized with elevated blood lead levels of 79 mcg/dL, microcytic anemia, and gastrointestinal symptoms, as well as having the characteristic burton lines along the gums. Imaging revealed radio-dense material in the colon, consistent with ingested paint chips. She required chelation therapy, bowel decontamination, and psychiatric evaluation. Her psychiatric assessment revealed compulsive urges to ingest paint, without evidence of underlying psychosis, intellectual disability, or obsessive-compulsive disorder. The patient ultimately completed chelation therapy without further complications with future follow-up with her outpatient primary care provider as well as a referral to outpatient behavioral health resources. Conclusion: This case underscores the importance of considering pica in the differential diagnosis for unexplained lead toxicity, especially in the context of iron deficiency. Early recognition and multidisciplinary management are essential to prevent long-term complications.