title: Lead, mercury, and arsenic poisoning due to topical use of traditional Chinese medicines.
abstract: BACKGROUND
  Metal poisonings through a mucocutaneous route are reported rarely in the literature.
  
  
  METHODS
  We report 2 cases of heavy metal intoxication from inappropriate use of Chinese mineral medicines confirmed by toxicologic investigations.
  
  
  RESULTS
  A 51-year-old man developed perianal gangrene and a high fever after a 2-week anal use of hong-dan herbal mixtures for anal fistula. He presented gastrointestinal and constitutional symptoms, followed by skin rash, anemia, hair loss, peripheral neuropathy, and muscle atrophy. Elevated urine arsenic and mercury confirmed the heavy metal poisonings. The hong-dan mixture contained lead tetraoxide, arsenic, and mercury. He was treated with 2,3-dimercapto-1-propanesulfonic acid, with partial improvement, but peripheral neuropathy persists 4 years later. A 75-year-old man developed anorexia, weight loss, headache, dizziness, nausea, vomiting, constipation, weakness, and anemia after a 3-month use of an herbal patch for chronic leg ulcer. His blood lead concentration was 226 μg/dL, and the lead content of the herbal patch was 517 mg/g. Chelation with ethylene diamine tetraacetic acid and dimercaptosuccinic acid was followed by clinical recovery.
  
  
  CONCLUSIONS
  These cases documented serious systemic poisoning after the short-term use of traditional Chinese medicines containing heavy metals in damaged or infected tissue.
authors.affiliation: Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Ming-Ling
authors.initials: ML
authors.lastname: Wu
authors.forename: Jou-Fang
authors.initials: JF
authors.lastname: Deng
authors.forename: Kon-Ping
authors.initials: KP
authors.lastname: Lin
authors.forename: Wei-Jen
authors.initials: WJ
authors.lastname: Tsai
mesh_terms: D000287:Administration, Topical; D000368:Aged; D020261:Arsenic Poisoning / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007855:Lead Poisoning / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008516:Medicine, Chinese Traditional / Q000009:adverse effects*; D008630:Mercury Poisoning / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged