In May, 2012, a 55-year-old man was referred to a clinic for severe heart failure (New York Heart Association class IV). He had raised brain natriuretic peptide of 1053 ng/L (normal <55 ng/L) and his estimated ejection fraction by echocardiography was 25%. His medical history was mostly uneventful, apart from the fact that he had had both hips replaced by prostheses. Coronary artery disease had been excluded by heart catheterisation; cardiomyopathy was therefore regarded as the cause of heart failure. Additionally he was almost deaf and almost blind; furthermore he had fever of unknown origin, hypothyroidism, and reflux oesophagitis…
Searching for the cause combining these symptoms – and remembering an episode of the TV series “House” which was used for teaching medical students- a cobalt hip intoxication was suspected as the most likely reason…