Late-onset Schizophrenia in a Man at Risk for Occupational Exposure to Neurotoxicants.

What is it about?

This is a rare case report of late-onset schizophrenia in which the differential diagnosis was complicated by a single elevated urine level of manganese (Mn) in a 40-year-old man who was self-employed as a jewelry maker. Exposure to Mn has been associated with reversible psychosis (Verhoeven et al., 2011). The patient, who had no family history of mental illness, presented to his primary care provider with symptoms of psychosis which had become progressively worse over a three-week period. Due to the patient's occupation which put him at risk for exposure to industrial chemicals, the possibility of a toxic etiology of his symptoms needed to be ruled out. An initial heavy metal screen revealed elevated urine Mn (23.3 ug/L, reference range 0.0-2.0 ug/L) suggesting the patient was suffering from Mn exposure-induced psychosis. Confirmatory tests of biological markers of Mn exposure in hair, urine and blood levels were all within normal limits. A subsequent workplace environmental hazard assessment showed that Mn levels were below the occupational exposure limits. Once occupational exposure to neurotoxicants was ruled out as an etiological risk factor, a diagnosis of late-onset schizophrenia was made.

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Why is it important?

This case report demonstrates the difficulty associated with making a differential diagnosis of neurologic and/or neuropsychiatric disease in patients at risk for occupational exposure to neurotoxicants. This clinical case report also demonstrates the importance of confirming initial laboratory results for biological markers of exposure before making a differential diagnosis of neurotoxicant-induced psychosis versus late-onset schizophrenia.

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