Elevated Lead, Nickel, and Bismuth Levels in the Peritoneal Fluid of a Peritoneal Endometriosis Patient without Toxic Habits or Occupational Exposure following a Vegetarian Diet Original paper

What was studied?

This case study investigated elevated lead, nickel, and bismuth levels in peritoneal fluid—a key extracellular environment that bathes endometriotic lesions—using ICP-MS/MS analysis. The focus keyphrase elevated lead nickel bismuth peritoneal endometriosis frames the central finding: unusually high concentrations of these potentially toxic elements in a young woman with peritoneal endometriosis despite lacking identifiable toxic or occupational exposures. The study examined how environmental contaminants, diet, and lifestyle might contribute to metal accumulation in the peritoneal cavity, a microenvironment increasingly recognized as influential in inflammatory and hormonal dysregulation relevant to endometriosis pathophysiology. This approach aligns with microbiome-informed clinical interests because toxic element accumulation can modulate immune tone, oxidative stress, and microbial community structure, indirectly shaping local inflammation and lesion activity.

Who was studied?

Researchers evaluated a 22-year-old woman diagnosed with peritoneal endometriosis during laparoscopic surgery. She was a nonsmoker, consumed no alcohol, and reported no occupational or environmental toxic exposures. Importantly, she followed a lacto-ovo vegetarian diet, a potential contributor to trace metal intake. Her peritoneal fluid results were compared with those of an age-matched control patient with a benign serous cystadenoma and with ten additional non-endometriosis controls. This comparative structure allowed investigators to contextualize abnormal metal concentrations and evaluate whether observed elevations were disease-specific or potentially linked to diet or unrecognized environmental exposure.

Most important findings

The most striking result was the extreme elevation of lead (90:1 ratio), accompanied by high nickel and bismuth levels. These potentially toxic elements have known interactions with endocrine and immune pathways, both relevant to endometriosis and potentially influential to microbiome dynamics given their antimicrobial and redox-active properties. Lead and nickel can disrupt estrogen receptor signaling, generate oxidative stress, alter immune cell activation, and shape cytokine patterns—mechanisms paralleling microbiome-mediated inflammatory modulation. The vegetarian diet, rich in plant-derived foods capable of accumulating soil-associated metals, may have contributed to exposure. Bismuth, though less studied in gynecologic contexts, has antimicrobial properties that could influence local microbial signatures in peritoneal or reproductive tissues. Cobalt and barium were also elevated, reinforcing the possibility of cumulative environmental or dietary exposure.

Key implications

These findings suggest that toxic metal accumulation in the peritoneal cavity may contribute to endometriosis development or severity, either directly through oxidative and endocrine disruption or indirectly by influencing microbial behavior, immune tone, and metabolic signaling within the peritoneal microenvironment. Though causality cannot be inferred from a single case, this study underscores the need for broader investigation of environmental exposures—including dietary sources—in reproductive pathology. The work also highlights the potential utility of peritoneal fluid metal signatures as biomarkers for endometriosis, helping integrate environmental toxicology with emerging microbiome-centered diagnostic frameworks.

Citation

López-Botella A, Gómez-Torres MJ, Sánchez R, Todolí-Torró JL, Velasco I, Acién M. Elevated lead, nickel, and bismuth levels in the peritoneal fluid of a peritoneal endometriosis patient without toxic habits or occupational exposure following a vegetarian diet. Toxics. 2023;11:1009. toxics-11-01009