Hugh Laurie only plays a doctor on TV, but he has a following among physicians in Germany who are crediting his fictional Dr. House with helping them diagnose a man with a life-threatening case of cobalt intoxication.
The 55-year-old patient was referred to their clinic in Marburg in May 2012 suffering from severe heart failure. An echocardiogram revealed that his ejection fraction – a measure of how well his heart was pumping blood – was only about 25%. (In a healthy person, it’s between 55% and 70%, according to the Cleveland Clinic.)
He also had extremely high levels of a hormone called brain natriuretic peptide, or BNP. The hormone is made by the heart, and if the heart is working well, it produces less than 55 nanograms per liter of blood. This patient’s BNP levels were measured at 1,053 ng/L.
Heart failure wasn’t the man’s only problem. The patient had mysteriously become nearly deaf and nearly blind; his thyroid gland had slacked off; he had gastroesophogeal reflux, or GERD; the lymph nodes near his left hip were enlarged; and he had a fever, according to a report published in Saturday’s edition of the medical journal Lancet.
The patient’s doctors were stumped, so they sent him to the clinic at Philipps University of Marburg. The medical team there noticed something significant from the patient’s medical history: In 2010, his ceramic artificial hip was replaced with a metal version.
This reminded them of an episode of the Fox medical drama “House” that they had screened for their medical students as a teaching case. In one of the story lines, the hospital administrator’s mother (played by Candice Bergen) had a mysterious illness that caused her to faint and sent her heart rate through the roof. Metal poisoning had been diagnosed and treated in the past, but Dr. House’s insight was to realize that the poisoning was ongoing – and that the source was an artificial metal hip.
The German doctors ordered a radiograph and found signs of metal debris near the metal hip. Blood tests showed concentrations of cobalt that were 1,000 times higher than normal and chromium levels that were 100 times higher than normal. Urine tests also found abnormally high levels of both metals.
The doctors initiated chelation treatment to remove the metals from his body. Then they sent him back to his orthopedic surgeons to have his metal hip replaced with a ceramic version. It turned out that the spherical portion of the hip prosthesis had been “severely damaged,” according to the Lancet report.
After it was out, the patient began to improve and his ejection fraction rose to 40%. However, 14 months later he still had very high blood levels of cobalt and chromium, and his hearing and vision were still impaired.
As a consequence of his heart failure, the patient also got an implanted cardioverter-defibrillator, or ICD, to keep his heart rate steady.
In their Lancet report, the German doctors advised their colleagues to consider cobalt poisoning as a cause of heart failure in patients with metal hips. Though cobalt intoxication has been known to cause cardiomyopathy for more than 50 years, it is usually considered a problem for people who are exposed to the metal in their jobs or for people who suffer from a condition known as “Quebec beer drinkers’ cardiomyopathy.”
The ailment got its name from a cluster of 50 heavy beer drinkers (they downed 24 pints of beer a day, on average) in Quebec City who developed the heart condition between August 1965 and April 1966; 20 of them died as a result. These cases were traced to the local Dow Brewery, which began adding cobalt sulfate to its Dow Ale in July 1965 “to improve the stability of the foam,” according to a fascinating account of the outbreak published in 1969 in the Annals of the New York Academy of Sciences.
After the case was cracked, Dow Brewery insisted in an advertisement that its beer was “perfectly good,” according to the 2001 book “Brewed in Canada: The Untold Story of Canada’s 350-year-old Brewing Industry,” by Allen Winn Sneath. However, it poured nearly 1 million gallons of unsold Dow Ale into the St. Lawrence River to assure beer drinkers that no tainted beer would ever reach their lips.
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