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Arsenical peripheral neuropathy
  1. Liberty Mathew1,
  2. Allister Vale2,
  3. Jane E Adcock3
  1. 1Specialist Registrar in Neurology, Department of Neurology, West Wing, John Radcliffe Hospital, Oxford, UK
  2. 2Director, National Poisons Information Service (Birmingham Unit) and West Midlands Poisons Unit, City Hospital, Birmingham, UK
  3. 3Consultant Neurologist, Department of Neurology, West Wing, John Radcliffe Hospital, Oxford, UK
  1. Dr J E Adcock, Department of Neurology, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; jane{at}fmrib.ox.ac.uk

Abstract

A 49-year-old white man returned urgently to the UK after spending 3 months in Goa. He had a several week history of vomiting, weight loss, a widespread desquamating skin rash, and symptoms and signs of a progressive painful sensorimotor neuropathy. He had a mild normocytic anaemia and lymphopenia. Nerve conduction studies revealed a severe predominantly axonal large fibre sensorimotor neuropathy, confirmed on subsequent sural nerve biopsy. Once he had left Goa most of his symptoms started to rapidly settle although the neuropathic symptoms remained severe. Arsenic poisoning was suspected. A spot urine arsenic concentration was 300 μg/l, confirming the diagnosis. He was treated with chelation therapy. Deliberate arsenic poisoning was highly likely.

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Footnotes

  • Competing interest None

  • Patient consent Obtained.

  • Provenance: Not commissioned; externally peer reviewed.

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