56-year-old woman's mysterious decline traced to cobalt poisoning from hip implant

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A 56-year-old woman was admitted to a hospital with an array of alarming symptoms that were only getting worse. For eight weeks, she had a painful "pins and needles" feeling that started in both of her feet and then began working its way up her legs. By the time she arrived at the hospital, she was unable to feel her feet on the ground. She frequently stumbled and clutched at walls to stay up. But the tingling numbness was moving into her hands, too. Then came neurological symptoms. She told her doctors about short-term memory problems and difficulty concentrating. She was irritable and had no appetite. She was experiencing heart palpitations, too.

According to a case report this week in the New England Journal of Medicine , her doctors looked through her medical history for clues, finding nothing that immediately stood out. She had high blood pressure, a history of anxiety and depression, and hypothyroidism (an underactive thyroid). They did notice that, although she had managed the thyroid problem for more than a decade at the same dose of medication, she had been switched four weeks earlier to a stronger dose. But the dosage change didn't immediately raise any red flags.

She also had a history of hip problems. Twenty years before, she had a hip replacement that stemmed from an injury she sustained in a car crash ten years before that. While more than 90 percent of hip replacements last at least 30 years, the woman's started failing her after 19.

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