Jornal de Toxicologia Clínica
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Arsenic Poisoning from Repeated Exposure to Burning Herbal Products Containing Realgar: A Case Report

Ngoc Thanh Cao, Thuy Hong Tran, Nguyen Khoi Huynh, Ngat Thi Nguyen, ML Wu

Background: 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.
Case details: A 39-year-old male developed intermittent fever, loss of appetite, hair loss and bluish discoloration of the trunk and limbs one year before admission, followed by diffuse thickening of soles and palms and gradually worsened tingling and numbness of distal parts of limbs and weakness of extremities over the course of the year prior to hospital admission. Characteristic clinical presentation of arsenic poisoning included hyperpigmentation, spotty raindrop pigmentation, Mees’ lines and high arsenic levels in the blood, urine and hair confirmed the diagnosis. Patient’s signs and symptoms significantly improved following termination of arsenic exposure and treatment.
Conclusion: Inhalation of pyrolyzed herbal products containing realgar resulted in arsenic poisoning. Our patient showed significant clinical improvement following termination of arsenic exposure and treatment. The adverse health effects of burning herbal products containing realgar are a serious public health issue.