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Intrasynovial lead, which does not undergo fibrous encapsulation, has been linked to lead intoxication. Clinical and experimental reports support removal of lead bodies from articular areas in an attempt reduce or slow the degeneration of affected joints. Nonmechanical effects of lead on intraarticular structures may lead to degenerative changes

A 13-year-old girl presented with epigastric pain, nausea, and heartburn. The patient had normal physical examination and blood tests. Upper endoscopy revealed bile reflux, cobblestone mucosa, and small nodule with whitish cap at the fundus (Figs 1 and 2). Gastric biopsies showed foveolar hyperplasia and foamy macrophages in the lamina propria, consistent with Helicobacter pylori gastritis and xanthelasma (Fig. 3). The patient was treated for H pylori, but her parents refused a second upper endoscopy to determine whether the lesion disappeared.Xanthelasma, a benign lesion, is a rare finding in the adult population with only 1 case reported in a child. In adults, it is mainly found in the gastric mucosa and occasionally in the esophagus or duodenum (1). The lesion appears as a yellowish-whitish nodule or plaque, single or multiple, from 0.5 to 10.0 mm (2,3). Etiology is unknown, but gastric xanthelasmas are seen when there are other pathological changes, such as chronic and atrophic gastritis, intestinal metaplasia, and bile reflux. Studies in adults show that these lesions are highly associated with H pylori infection (4). Although these lesions are not at increased risk for gastric cancer, biopsies are recommended to differentiate them from gastric tumors (3). Follow-up should include upper endoscopy to better understand the behavior of these lesions.

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