Tardily accelerated neurologic deterioration in two-step thallium intoxication.
Thallium intoxication was reported in cases with accidental ingestion, suicide attempt, and criminal adulteration. Reported cases were mostly one-time ingestion, therefore, the clinical course of divisional ingestion has not been fully known. Here, we report a case with two-step thallium intoxication manifesting as tardily accelerated neurologic deterioration. A 16-year-old adolescent was cryptically poisoned with thallium sulfate twice at an interval of 52days. After the first ingestion, neurologic symptoms including visual loss, myalgia, and weakness in legs developed about 40days after the development of acute gastrointestinal symptoms and alopecia. After the second ingestion, neurologic symptoms deteriorated rapidly and severely without gastrointestinal or cutaneous symptoms. Brain magnetic resonance imaging exhibited bilateral optic nerve atrophy. Nerve conduction studies revealed severe peripheral neuropathies in legs. Thallium intoxication was confirmed by an increase in urine thallium egestion. Most of the neurologic manifestations ameliorated in two years, but the visual loss persisted. The source of thallium ingestion was unraveled afterward because a murder suspect in another homicidal assault confessed the forepast adulteration. This discriminating clinical course may be attributable to the cumulative neurotoxicity due to the longer washout-time of thallium in the nervous system than other organs. It is noteworthy that the divisional thallium intoxication may manifest as progressive optic and peripheral neuropathy without gastrointestinal or cutaneous symptoms.
Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: dakuro@med.tohoku.ac.jp.
Hiroshi
H
Kuroda
Department of Neurology, Izumi Hospital, Sendai, Japan.
Yoshiyuki
Y
Mukai
Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Shuhei
S
Nishiyama
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Takayuki
T
Takeshita
Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Maki
M
Tateyama
National Hospital Organization Nishitaga Hospital, Sendai, Japan.
Atsushi
A
Takeda
Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Masashi
M
Aoki
D000293:Adolescent; D000505:Alopecia / Q000139:chemically induced; D020260:Heavy Metal Poisoning, Nervous System / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009901:Optic Nerve Diseases / Q000139:chemically induced*; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D012378:Rodenticides / Q000506:poisoning*; D013793:Thallium / Q000506:poisoning*
D012378:Rodenticides; D013793:Thallium; C013707:thallium sulfate
Alopecia; Mees’ line; Optic neuropathy; Peripheral neuropathy