A middle aged man from West Bengal presents with paraesthesia of hands and feet, hyperkeratosis, lines in the nails and rain drop pigmentation in the hands. The most likely causative toxin for the above mentioned symptoms is:
Correct Answer: Arsenic
Description: The symptoms mentioned in the question are classic features of chronic arsenic poisoning. Chronic Arsenic poisoning: It is insidious in nature. The onset of symptoms usually occurs after 2-8 weeks of exposure. Chronic poisoning may occur among persons engaged in smelting and refining of ores and in the subliming of arsenic in the manufacture of weed killers, dyes etc. Clinical Features of Chronic Arsenic poisoning: GIT symptoms: loss of weight, malaise, loss of appetite, salivation, colicky pain, diarrhoea and vomiting. Liver: Hepatomegaly, jaundice, cirrhosis Skin symptoms: usually begin with a persistent erythematous flush leading to hyperkeratotic skin and desquamation. Hyperkeratosis is most prominent in the distal pas of the body. Pigmentation is patchy ('raindrops pigmentation). Skin cancer (Squamous cell carcinoma and basal cell carcinoma) also occurs. Nails: Aldrich Mees lines (transverse white striae of the fingernails) may also be seen. Hairs: Alopecia occurs Hematological: Anaemia, leukopenia, Thrombocytopenia and Bone marrow hypoplasia are seen. Anaemia is normocytic and normochromic Peripheral neuropathy: Sensory and motor polyneuritis (sensory symptoms usually predominate) manifesting as numbness and tingling in a 'stocking glove' distribution. Blackfoot disease: Due to platelet activation and hypercoagulability of blood in peripheral aeries. Encephalopathy Nephritis
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