title: Arsenic intoxication presenting with macrocytosis and peripheral neuropathy, without anemia.
abstract: A case of arsenic intoxication associated with macrocytosis and neuropathy, without anemia, is presented. Evaluation of a 68-year-old man with a long history of peripheral neuropathy and persistent macrocytosis revealed exposure to an insecticide. Analysis of urine and hair revealed elevated levels of arsenic. A short course of d-penicillamine failed to promote urinary excretion of arsenic. Removal of the insecticide resulted in resolution of macrocytosis and slight improvement of neuropathy. This case emphasizes that arsenic intoxication should be considered in patients with macrocytosis with peripheral neuropathy, even in the absence of anemia.
authors.affiliation: Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200.
authors.forename: R
authors.initials: R
authors.lastname: Heaven
authors.forename: M
authors.initials: M
authors.lastname: Duncan
authors.forename: S J
authors.initials: SJ
authors.lastname: Vukelja
mesh_terms: D000368:Aged; D020261:Arsenic Poisoning; D002908:Chronic Disease; D004913:Erythrocytes, Abnormal / Q000187:drug effects*; D006801:Humans; D007306:Insecticides / Q000506:poisoning; D008297:Male; D010396:Penicillamine / Q000008:administration & dosage; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011041:Poisoning / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D011086:Polycythemia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D007306:Insecticides; D010396:Penicillamine