An 11-month-old boy weighing 6.75 kg, resident of a rural area of West Bengal, presented with first episode of generalized convulsions without fever or any other sign of infection. Hemoglobin was 5.2 g/dL with hypochromic microcytic picture, normal reticulocyte count (1.8%), low ferritin (19 ng/mL) and a negative direct Coomb’s test. C-reactive protein was negative; hemoglobin electrophoresis and magnetic resonance imaging of brain were within normal limits. X-ray of the wrists showed features of rickets along with prominent lines on the metaphyseal ends of the long bones and short bones of the hands. Vitamin D level (13.3 ng/mL) was low. A high blood lead level (121.8 µg/dL) and urine lead level (44.8 µg/dL) along with metaphyseal lead lines documented lead poisoning. History revealed that the family had a small lead battery assembly workshop at home. The child also had pica.

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