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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 microg/l, confirming the diagnosis. He was treated with chelation therapy. Deliberate arsenic poisoning was highly likely.

Original publication

DOI

10.1136/jnnp.2009.201830

Type

Journal article

Journal

Pract Neurol

Publication Date

02/2010

Volume

10

Pages

34 - 38

Keywords

Arsenic Poisoning, Diagnosis, Differential, Humans, Male, Middle Aged, Neural Conduction, Peripheral Nerves, Sural Nerve