Arsenic Poisoning from Repeated Exposure to Burning Herbal Products


Journal of Clinical Toxicology is an open access peer reviewed journal which publishes articles bi-monthly. Journal provides rapid peer review process. Recently journal has published its 2nd bi-monthly issue of its 10th volume with 5 regular articles and an editorial note.


In its 2nd issue of 10th volume Journal of Clinical Toxicology has published a case-report regarding Arsenic Poisoning from Repeated Exposure to Burning Herbal Products Arsenic poisoning from repeated exposure to burning herbal products containing realgar has not been reported in the literature. We report a case of arsenic poisoning from repeated exposure to burning traditional Chinese herbal products containing realgar for more than one year.

A 39-year-old male presented to an emergency department with nausea and vomiting. The patient was admitted to our rheumatology department because his history, physical examination and laboratory findings (e.g., fever, weight loss, skin lesions, cytopenia, gastrointestinal and neurological involvement) were thought to be consistent with an autoimmune disease. He denied occupational exposure as a real estate agent, denied excessive alcohol use and was on tenofovir treatment for hepatitis B for the past year. Other family members denied symptoms and remarkable past medical history. They had a regular diet with one or two portions of fish or seafood a week, neither of contaminated water intake and direct use of realgar. As the patient believed burning herbal products containing realgar would bring good fortune, he intermittently burned the herbal products for almost 10 years and the frequency increased to four time per month since 1 year ago and he stopped the behavior four months before admission.

The patient’s symptoms onset was about one year ago when he first developed intermittent fever and loss of appetite, followed by hair loss and bluish discoloration of the skin of the trunk and limbs. Nine months before the admission, he developed diffuse thickening of soles and palms as well as a gradual worsening of tingling and numbness of distal parts of limbs. Five months before the admission, he was unable to climb stairs and rise from a chair due to muscle weakness, which worsened to the point that he was bedridden for several days before presenting to an emergency department. He had recurrent nausea and vomiting throughout the 2 months prior to presentation. During the course of this past year, the patient presented to three different healthcare facilities, but was misdiagnosed as dermatomyositis, Guillain-Barre syndrome and discharged each time. Physical examination showed normal vital signs, hyperkeratosis on the skin of the upper back, spotty raindrop pigmentation on the palms and soles, Mees’ lines over the nails of fingers and toes (Figure 1). Other clinical findings included distal muscle weakness, muscle atrophy, distal paraesthesia with stocking-glove distribution and weight loss of 20 kg over the past year.

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