Acute toxic neuropathy mimicking guillain barre syndrome

A bstract Pancytopenia is a common hematological abnormality encountered in clinical practice. We here report a 36-year-old male who presented to emergency department with complaints of weakness of bilateral lower limbs, burning sensation in all four limbs with history of loose stools, and vomiting 5 days back. The complete blood count of patient showed pancytopenia with no circulating atypical cells. Bone marrow examination performed showed nonspecific but characteristic findings. After excluding the possibility of infective etiology, a possibility of heavy metal toxicity was suspected in multidisciplinary meeting. The urine and blood levels of arsenic done came out very high, and a diagnosis of arsenic poisoning was made. Patient had multisystemic involvement with features characteristic of arsenic poisoning. The present case was a diagnostic challenge in face of nonforthcoming history. This case beautifully highlighted the importance of multidepartmental approach in such cases to arrive at unerring diagnosis and the unique bone marrow findings, although nonspecific were sufficient enough to indicate the possibility of acute insult to the hematopoiesis. How to cite this article: Nair RR, Singh PK, Sharma J, Gambhir I, Khanna S, Jain AK, et al . An Unusual Case of Pancytopenia: The Lessons Learnt. Indian J Crit Care Med 2022;26(1):141–144.

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“… 2 The peripheral neuropathy, as seen in the present case, is common in arsenic toxicity and can mimic GBS clinically. 3 …”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Pancytopenia: The Lessons Learnt

Sharma¹,

Khanna²,

Singh³

et al. 2022

Indian Journal of Critical Care Medicine

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“…The classical GBS is considered the most common and most severe acute paralytic neuropathy with a worldwide overall incidence of about 1.3:100 000 per annum (Willison, Jacobs, & van Doorn, ) and about 0.6:100 000 in children <15 years of age (McGrogan, Madle, Seaman, & de Vries, ). None the less, a misdiagnosis of GBS in arsenic polyneuropathy is not infrequent, and there are several reports of arsenic‐induced sensorimotor neuropathy mimicking GBS with or without any systemic manifestation of arsenic intoxication affecting groups of arsenic‐exposed people (Barton & McLean, ; Donofrio et al, ; Franzblau & Lilis, ; Gear, ; Jalal, Fernandez, & Menon, ; Kim et al, ; Mathew, Vale, & Adcock, ). In 2011, the crude incidence rate of GBS in Bangladesh, a country where anthropogenic environmental arsenic contamination is endemic, in children <15 years of age, appeared to be 2.5× to 4× higher than that reported in the literature (Islam et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Chronic arsenic neuropathy may be misdiagnosed also because (Goddard, Tanhehco, & Dau, 1992;Oh, 1991 intoxication affecting groups of arsenic-exposed people (Barton & McLean, 2013;Donofrio et al, 1987;Franzblau & Lilis, 1989;Gear, 1984;Jalal, Fernandez, & Menon, 2015;Kim et al, 2012;Mathew, Vale, & Adcock, 2010). In 2011, the crude incidence rate of GBS in Bangladesh, a country where anthropogenic environmental arsenic contamination is endemic, in children <15 years of age, appeared to be 2.5× to 4× higher than that reported in the literature (Islam et al, 2011).…”

Section: Arsenic Neuropathymentioning

confidence: 97%

Chronic arsenic intoxication diagnostic score (CAsIDS)

Dani

Walter

2017

J of Applied Toxicology

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Arsenic and its compounds are well-established, potent, environmentally widespread and persistent toxicants with metabolic, genotoxic, mutagenic, teratogenic, epigenetic and carcinogenic effects. Arsenic occurs naturally in the Earth's crust, but anthropogenic arsenic emissions have surmounted the emissions from important natural sources such as volcanism. Inorganic arsenicals exhibit acute and chronic toxicities in virtually all cell types and tissues, and hence arsenic intoxication affects multiple systems. Whereas acute arsenic intoxication is rare and relatively easy to diagnose, chronic arsenic intoxication (CAsI) is common but goes often misdiagnosed.Based on a review of the literature as well as our own clinical experience, we propose a chronic arsenic intoxication diagnostic score (CAsIDS). A distinctive feature of CAsIDS is the use of bone arsenic load as an essential criterion for the individual risk assessment of chronic arsenic intoxication, combined with a systemic clinical assessment. We present clinical examples where CAsIDS is applied for the diagnosis of CAsI, review the main topics of the toxicity of arsenic in different cell and organ systems and discuss the therapy and prevention of disease caused or aggravated by chronic arsenic intoxication. CAsIDS can help physicians establish the diagnosis of CAsI and associated conditions.

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“…Peripheral neuropathy is the most common reaction of the nervous system against toxic chemical substances. Although the cause that leads to injury is not clearly known in toxic neuropathies, industrial, environmental and biologic agents, heavy metals, and pharmacologic agents may lead to this picture (1, 2). Neuronal injury may be in the form of distal axonal degeneration (axonopathy), degeneration of the neuronal body (neuronopathy) or primary demyelination (myelinopathy).…”

Section: Introductionmentioning

confidence: 99%

“…Acute neuropathies are misdiagnosed as GBS because electrophysiologic and clinical findings support GBS and specific diagnostic tests or biologic tests are not easily accessible (1, 2). We present a case of acute polyneuropathy mimicking GBS following exposure to pepper spray because it is noteworthy.…”

Section: Introductionmentioning

confidence: 99%

Biber gazı maruziyeti sonucu gelişen Guillain-Barre sendromunu taklit eden polinöropati

et al. 2019

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Peripheral neuropathy is the most common reaction to toxic chemical substances in the nervous system. Toxic neuropathies are often misdiagnosed because there are no easily available specific or biologic tests for the diagnosis. Guillain-Barre syndrome is the most common cause of acute flaccid paralysis in children and adolescents. Clinical signs of the disease are often at the beginning of the distal symmetric weakness and areflexia progresses rapidly. Although capsaicin is widely used in the treatment of so many diseases, especially of neuropathic pain, cancer and osteoarthritis, it is known to be toxic in many systems such as the eye, skin, respiratory, and circulatory systems. Although there is inadequate information about its long-term effects, it has also been reported that in large quantities there is increased risk of toxicity and prolonged exposure can lead to death. In our case, we present acute polyneuropathy mimicking Guillain-Barre syndrome after exposure to pepper spray because it is noteworthy and interesting.

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Acute toxic neuropathy mimicking guillain barre syndrome

Cited by 6 publications

References 4 publications

An Unusual Case of Pancytopenia: The Lessons Learnt

An Unusual Case of Pancytopenia: The Lessons Learnt

Chronic arsenic intoxication diagnostic score (CAsIDS)

Biber gazı maruziyeti sonucu gelişen Guillain-Barre sendromunu taklit eden polinöropati

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