Acute arsenic poisoning: clinical and histopathological features

Abstract

We report a woman with acute arsenic poisoning, who developed an erythroderma with vesicles and pustules after the ingestion of 8-16 g of sodium arsenite. Simultaneously, she presented a herpes simplex virus infection. Skin biopsies showed unique features which included multiple small pigment granules inside and outside the histiocytes. In our opinion, these findings are consistent with acute arsenic poisoning, and constitute the first histological description of this entity in skin.

Massive acute arsenic poisonings

“…It also binds to enzymes in the Krebs tricarboxylic acid cycle, thereby interfering with oxidative phosphorylation. This causes widespread endothelial cellular toxicity, resulting in capillary damage, generalised vasodilatation and transudation of plasma, and shock [9,11,14].…”

“…Although arsenic poisonings are not as frequent as 20-30 years ago, nevertheless they are still important in the field of toxicology [4,5,7,[9][10][11][12]14,16,[18][19][20][21]. In recent years, there have usually been cases of suicidal or homicidal poisonings by ingestion of known or unknown amounts of, for the most part, arsenic(III) oxide [11,12,14,16,18,20,21], sometimes sodium arsenite [8,9], sodium arsenate [10], arsenic(III) chloride [22] or metallic arsenic [20,23].…”

“…In recent years, there have usually been cases of suicidal or homicidal poisonings by ingestion of known or unknown amounts of, for the most part, arsenic(III) oxide [11,12,14,16,18,20,21], sometimes sodium arsenite [8,9], sodium arsenate [10], arsenic(III) chloride [22] or metallic arsenic [20,23].…”

“…Accidental poisonings appear to be most common in the children [6][7][8], and occur occasionally in the older agegroup [1], whereas intentional and covert poisonings predominate in adults [4,6,[9][10][11][12][14][15][16]18,[20][21][22]. Most acute poisonings are fatal [1][2][3][4][5][7][8][9][10][11][12][13][14]18,[20][21][22], although some poisonings end in recovery [9,15,16,20].…”

Chronic exposure to arsenite induces S100A8 and S100A9 expression in rat RBL-2H3 mast cells

“…Infection with herpes simplex virus was also reported in a case of acute arsenic poisoning (Bartolomé et al, 1999). Patients with arsenic-induced Bowen's disease showed immune dysfunctions detected by decreases in the number of Langerhans cells in the skin (Wang et al, 1991) and by decreases in cutaneous and systemic CD4+ cells (Liao et al, 2009).…”