1. Cobalt toxicity: a preventable and treatable cause for possibly life threatening cardiomyopathy.
- Author
-
Giacon G and Boon K
- Subjects
- Arthroplasty, Replacement, Hip instrumentation, Cardiomyopathies diagnosis, Cobalt blood, Echocardiography, Fatal Outcome, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Prosthesis Failure adverse effects, Radiography, Thoracic, Arthroplasty, Replacement, Hip adverse effects, Cardiomyopathies chemically induced, Cobalt toxicity, Hip Prosthesis adverse effects
- Abstract
Mr BH was a 53-year-old gentleman who presented to hospital in November 2019 with decompensated heart failure, new-onset paroxysmal atrial tachycardia and increasing left hip pain. Imaging of his hip demonstrated radiographic evidence of bony changes, suggestive of an adverse reaction to metal debris (ARMD), along with a non-traumatic left peri-prosthetic neck-of-femur fracture. Clinically, he had concurrent decompensated cardiomyopathy requiring dopamine and furosemide infusions. His serum cobalt (sCo) levels were 5244nmol/L (normal<12nmol/L). He had previous bilateral total hip arthroplasties using the Birmingham Hip Resurfacing (right side 2006, left side 2012). As part of routine metal-on-metal arthroplasty follow-up, Mr BH had sCo level checks. In 2013, these levels rose to 1981nmol/L. Although there has been no direct correlation between sCo levels and toxicity, levels above 119nmol/L are concerning. Unfortunately, Mr BH moved to a different health district and was subsequently lost to follow-up. In 2015, Mr BH was diagnosed with dilated cardiomyopathy, presumed secondary to viral myocarditis. Despite successful chelating therapy and heart failure treatment, he passed away secondary to cobalt-toxicity induced cardiomyopathy (CTCM)., Competing Interests: Nil.
- Published
- 2021