TV show House helped doctors spot cobalt poisoningBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1424 (Published 07 February 2014) Cite this as: BMJ 2014;348:g1424
The US television series House helped doctors in Germany diagnose cobalt intoxication from a hip replacement in a patient with severe heart failure.
A 55 year old man was referred to a clinic at Philipps-University Marburg in Germany after presenting with hypothyroidism, oesophagitis, fever of unknown origin, increasing deafness, and loss of sight and eventually severe heart failure. Heart catheterisation had ruled out coronary artery disease, said the case report in the Lancet.1
The doctors noticed several similarities between the patient’s symptoms and those of a fictional patient in the series House, whose lead character is a diagnostic physician. Dr House, played by the UK actor Hugh Laurie, had diagnosed cobalt poisoning caused by debris from a metal hip replacement.
A year and a half earlier the man had undergone a metal-on-plastic hip replacement to replace a broken ceramic-on-ceramic hip prosthesis. The doctors carried out radiography of the hip, which showed a myositis ossificans-like picture attributable to metal debris. Blood tests showed high concentrations of cobalt and chromium.
The patient was referred for a new left ceramic hip prosthesis. Subsequently his heart function improved, and he has experienced no new episodes of fever or acid reflux. However, the patient’s hearing and sight recovered only slightly.
Cobalt poisoning has been a known cause of cardiomyopathy for over 50 years but is mainly associated with steel workers exposed to the metal or in cases of food or drink contaminated by cobalt.
Juergen Schaefer, the case report’s lead author and director of the Center for Undiagnosed Diseases in Marburg, said, “Numerous studies have investigated metal exposure due to hip replacements, but in certain situations—where the placement has gone wrong, where there are technical problems with the prosthesis, and strikingly often after an off-label replacement of broken ceramic hips by metal parts—patients are at risk of cobalt poisoning due to hip prosthesis, a problem which appears to be on the increase and which can be life threatening.”
A UK orthopaedic surgeon wrote to the BMJ about five cases of probable arthroprosthetic cobaltism associated with metal-on-metal hip implants.2 And in 2012 an investigation by the BMJ showed how hundreds of thousands of patients around the world may have been exposed to toxic substances after being implanted with metal-on-metal hip implants.3
Cite this as: BMJ 2014;348:g1424