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Documenta Ophthalmologica
Published in: Documenta Ophthalmologica 1/2013

01-02-2013 | Clinical Case Report

Cobalt–chromium toxic retinopathy case study

Authors: Warren Apel, Denis Stark, Anthony Stark, Stephen O’Hagan, Joseph Ling

Published in: Documenta Ophthalmologica | Issue 1/2013

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Abstract

Purpose

To report the clinical case of a 65-year-old male who developed retinal dysfunction following cobalt–chromium toxicity.

Methods

A review of the clinical, haematological, radiological and electrophysiological investigations into a single patient was performed in order to form a case report.

Results

A 65-year-old male presented to his ophthalmologist with a 1-year history of worsening vision on the background of a multisystem illness including motor axonopathy, pericardiomyopathy and bulbar palsy. His medical history included hypertension, hypercholesterolaemia and a metallic hip prosthesis. Ocular examination revealed significantly reduced visual acuity bilaterally along with very poor colour vision. Cornea, fundi and optic discs all appeared normal. Bilateral moderate nuclear sclerosis was noted. Basic investigations including mitochondrial studies, auto-immune screen and MRI of brain were unremarkable. Further investigations showed significantly elevated plasma cobalt and chromium levels. Electrophysiological studies revealed an abnormality in all phases of the ERG including a negative b-waveform, suggestive of inner retinal pathology. Following subsequent revision of the hip, cobalt and chromium levels decreased and the patient’s vision improved. Further electrophysiological testing indicates a persistent ERG abnormality despite a significant improvement in both the patient’s visual acuity and colour vision.

Conclusions

These results suggest that cobalt–chromium toxicity can cause inner retinal dysfunction.
Literature
1.
Varela-Moreiras G, Murphy MM, Scott JM (2009) Cobalamin, folic acid, and homocysteine. Nutr Rev 67:S67–S72CrossRef
2.
Catalani S, Rizzetti MC, Padovani A, Apostoli P (2012) Neurotoxicity of cobalt. Hum Exp Toxicol 31(5):421–437PubMedCrossRef
3.
Travacio M, Polo J, Llesuy S (2001) Chromium(VI) induces oxidative stress in the mouse brain. Toxicology 162:139–148PubMedCrossRef
4.
Dayan A, Paine A (2001) Mechanisms of chromium toxicity, carcinogenicity and allergenicity: review of the literature from 1985 to 2000. Hum Exp Toxicol 20:439–451PubMedCrossRef
5.
Costa M, Klein C (2006) Toxicity and carcinogenicity of chromium compounds in humans. Crit Rev Toxicol 36:155–163PubMedCrossRef
6.
Qi W, Reiter R, Tan D, Manchester L, Siu A, Garcia J (2000) Increased levels of oxidatively damaged DNA induced by chromium(III) and H202: protection by melatonin and related molecules. J Pineal Res 29:54–61PubMedCrossRef
7.
Isaac GH, Siebel T, Oakeshott RD, McLennan-Smith R, Cobb AG, Schmalzried TP, Vail TP (2009) Changes in whole blood metal ion levels following resurfacing: serial measurements in a multi-centre study. Hip Int 19:330–337PubMed
8.
Tower S (2010) Arthroprosthetic cobaltism: identification of the at-risk patient. Alaska Med 52:28–32PubMed
9.
Sadler PJ, Tucker A, Viles JH (1994) Involvment of a lysine residue in the N-terminal Ni2+ and Cu2+ binding site of serum albumins. Comparison with Co2+, Cd2+ and Al3+. Eur J Biochem 220:193–200PubMedCrossRef
10.
Catalani S, Leone R, Rizzetti MC, Padovani A, Apostoli P (2011) The role of albumin in human toxicology of cobalt: contribution from a clinical case. ISRN Hematol Vol 2011: Article ID 690620
11.
Gallemore RP, Steinberg RH (1991) Cobalt increases photoreceptor-dependent responses of the chick retinal pigment epithelium. Invest Ophthalmol Vis Sci 32(12):3041–3052PubMed
12.
Karovic O, Tonazzini I, Rebola N, Edstrom E, Lovdahl C, Fredholm B, Dare E (2007) Toxic effects of cobalt in primary cultures of mouse astrocytes: similarities with hypoxia and role of HIF-1. Biochem Pharmacol 73:694–708PubMedCrossRef
13.
Brown M, Voljavec A, Lott M, Macdonald I, Wallace D (1992) Leber’s hereditary optic neuropathy: a model for mitochondrial neurodegenerative diseases. FASEB J 6:2791–2799PubMed
14.
Seghizzi P, D’Adda F, Borleri D, Barbic F, Mosconi G (1994) Cobalt myocardiopathy: a critical review of literature. Sci Total Environ 150:105–109PubMedCrossRef
15.
Carelli V, Ross-Cisneros F, Sadun A (2004) Mitochondrial dysfunction as a cause of optic neuropathies. Progr Retinal Eye Res 23:53–89CrossRef
16.
Hara A, Niwa M, Aoki H, Kumada M, Kunisada T, Oyama T, Yamamoto T, Kozawa O, Mori H (2006) A new model of retinal photoreceptor cell degeneration induced by a chemical hypoxia-mimicking agent, cobalt chloride. Brain Res 1109:192–200PubMedCrossRef
17.
Meecham HM, Humphrey P (1991) Industrial exposure to cobalt causing optic atrophy and nerve deafness: a case report. J Neurol Neurosurg Psychiatry 54:374–375PubMedCrossRef
18.
Licht A, Oliver M, Rachmilewitz E (1972) Optic atrophy following treatment with cobalt chloride in a patient with pancytopenia and hypercellular marrow. Isr J Med Sci 8:61–66PubMed
19.
Bhardwaj N, Perez J, Peden M (2011) Optic neuropathy from cobalt toxicity in a patient who ingested cattle magnets. Neuro-ophthalmology 35(1):24–26CrossRef
20.
Steens W, von Foerster G, Katzer A (2006) Severe cobalt poisoning with loss of sight after ceramic-metal pairing in a hip—a case report. Acta Orthopedica 77(5):830–832CrossRef
21.
Tower S (2010) Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty. J Bone Joint Surg 92:2847–2851PubMedCrossRef
22.
Rizzetti MC, Liberini P, Zarattini G, Catalani S, Pazzaglia U, Apostoli P, Padovani A (2009) Loss of sight and sound. Could it be the hip? Lancet 373:1052PubMedCrossRef
23.
Rizzetti MC, Catalani S, Apostoli P, Padovani A (2011) Cobalt toxicity after total hip replacement: a neglected adverse affect? Muscle Nerve 43(1):146–147PubMedCrossRef
24.
Alagna G, D’Acquino S (1956) Alterazioni oculari da cloruro di cobalto. Archivio di Ottalmologia 60:5–29
25.
Monies A, Prost M (1994) Experimental studies on lesions of eye tissues in cobalt intoxication. Klin Oczna 96:135–139PubMed
26.
Yuan L, Yang X (1997) Selective suppression of rod signal transmission by cobalt ions of low levels in carp retina. Sci China Ser C 40(2):128–136CrossRef
27.
Evans J, Hood D, Holtzman E (1978) Differential effects of cobalt ions on rod and cone synaptic activity in the isolated frog retina. Vis Res 18:145–151PubMedCrossRef
28.
Dong C, McReynolds J, Qian H (1990) Time-dependent differential effects of cobalt ions on rod- and cone-driven responses in the isolated frog retina. Vis Neurosci 4(4):359–365PubMedCrossRef
29.
Khosla PK, Murthy KS, Tewari HK (1987) Retinal toxicity of trace elements. Indian J Ophthalmol 35(5–6):311–314PubMed
30.
Wesseling C, Pukkala E, Neuvonen K, Kauppinen T, Boffetta P, Partnanen T (2002) Cancer of the brain and nervous system and occupational exposures in finnish women. JOEM 44(7):663–668PubMed
31.
Duckett S (1986) Abnormal deposits of chromium in the pathological human brain. J Neurol Neurosurg Psychiatry 49:296–301PubMedCrossRef
32.
Gibb H, Lees P, Pinsky P, Rooney B (2000) Lung cancer among workers in chromium chemical production. Am J Ind Med 38:115–126PubMedCrossRef
33.
Kirpnick-Sobol Z, Reliene R, Schiestl R (2006) Carcinogenic Cr(VI) and the nutritional supplement Cr(III) induce DNA deletions in yeast and mice. Cancer Res 66(7):3480–3484PubMedCrossRef
34.
Asmatullah S, Shakoori A (1998) Embryotoxic and teratogenic effects of hexavalent chromium in developing chicks of gallus domesticus. Bull Environ Contam Toxicol 61:281–288PubMedCrossRef
35.
Ventura D, Costa MTV, Costa MF, Berezovsky A, Salomao S, Simoes A, Lago M, Pereira L, Faria M, De Souza J, Silveira L (2004) Multifocal and full-field electroretinogram changes associated with color-vision loss in mercury vapor exposure. Vis Neurosci 21:421–429PubMedCrossRef
36.
El-Sherbeeny A, Odom J, Smith J (2006) Visual system manifestations due to systemic exposure to mercury. Cutan Ocul Toxicol 25:173–183PubMedCrossRef
37.
Schechner R, Miller B, Merksamer E, Perlman I (1991) A long term follow up of ocular siderosis: quantitative assessment of the electroretinogram. Doc Ophthalmol 76:231–240CrossRef
38.
He X, Hahn P, Iacovelli J, Wong R, King C, Bhisitkul R, Massaro-Giordano M, Dunaief J (2007) Iron homeostasis and toxicity in retinal degeneration. Prog Retin Eye Res 26(6):649–673PubMedCrossRef
39.
Nagpal A, Brodie S (2009) Supranormal electroretinogram in a 10-year-old girl with lead toxicity. Doc Ophthalmol 118:163–166PubMedCrossRef
40.
Rothenberg S, Schnaas L, Salgado-Valladares M, Casanueva E, Geller A, Hudnell H, Fox D (2002) Increased ERG a- and b-wave amplitudes in 7- to 10-year-old children resulting from prenatal lead exposure. Invest Ophthalmol Vis Sci 43(6):2036–2044PubMed
41.
Lilienthal H, Kohler K, Turfeld M, Winneke G (1994) Persistent increases in scotopic B-wave amplitudes after lead exposure in monkeys. Exp Eye Res 59:203–209PubMedCrossRef
42.
Fox D, Kala S, Hamilton W, Johnson J, O’Callaghan J (2008) Low-level human equivalent gestational lead exposure produces supernormal scotopic electroretinograms, increased retinal neurogenesis, and decreased retinal dopamine utilization in rats. Environ Health Perspect 116(5):618–625PubMedCrossRef
43.
Audo I, Robson A, Holder G, Moore A (2008) The negative ERG: clinical phenotypes and disease mechanisms of inner retinal dysfunction. Surv Ophthalmol 53:16–40PubMedCrossRef
44.
Dahlmann A, McCormack D, Jarrison R (2001) Bilateral hypoperfusion retinopathy. J R Soc Med 94:298–299PubMed
45.
Levin L (2001) Method of reducing retinal ganglion cell degeneration. United States Patent, US6291506B1
Metadata
Title
Cobalt–chromium toxic retinopathy case study
Authors
Warren Apel
Denis Stark
Anthony Stark
Stephen O’Hagan
Joseph Ling
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Documenta Ophthalmologica / Issue 1/2013
Print ISSN: 0012-4486
Electronic ISSN: 1573-2622
DOI
https://doi.org/10.1007/s10633-012-9356-8

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