Background Drugs containing bismuth, although usually safe, may rarely cause neurotoxicity. Case presentation We describe the case of a 44-year-old woman treated with bismuth subsalicylate for about 20 years, who developed abnormal behaviour and postural instability in two weeks. On examination, she had greyish discoloration of teeth, was confused and presented generalized myoclonic jerks. In the next days, her clinical condition deteriorated, with a reduction in alertness and more exuberant myoclonus. Brain MRI was unremarkable. CSF revealed mild elevation of protein content (47 mg/dL; reference range: 15-45 mg/dL) and elevation of white blood cell count (10/μL). Bismuth levels in urine (375 μg/L), serum (260 μg/L) and CSF (21.4 μg/L) samples were highly above the threshold for toxicity. Following supportive treatment and bismuth discontinuation, she made a full recovery within weeks. Conclusions Although rare, bismuth encephalopathy should be considered in patients presenting with subacute encephalopathy and myoclonus. This encephalopathy can be subacute even after a chronic exposure. Cessation of bismuth can lead to a complete resolution in weeks.
She had a past medical history of insomnia and irritable bowel syndrome and was currently being treated with vitamin D3, vitamin K, manganese and activated charcoal.
She was either self-treating, following the suggestions of an internet “doctor”, or taking medical advice from a chiropractor 😂
Note, irritable bowel syndrome isn’t the same as inflammatory bowel disease (I.e. Crohn’s). And IBD isn’t treated with pepto bismal, either. 💁♂️
She probably had Crohn’s and treated it with Pepto
She was either self-treating, following the suggestions of an internet “doctor”, or taking medical advice from a chiropractor 😂
Note, irritable bowel syndrome isn’t the same as inflammatory bowel disease (I.e. Crohn’s). And IBD isn’t treated with pepto bismal, either. 💁♂️