Case of aluminium poisoning, with differential diagnosis for amyotrophic lateral sclerosis (als)

Abstract

Introduction: Essential metals in high quantities can accumulate and reach toxicity. In the CNS, they lead to neurodegeneration, causing movement and cognitive disorders. Case Report: White man, 59 years, sanitation agent, uses PPE irregularly. For 1 year presented progressive speech disorder, paresis, emaciation, dysphonia, tongue atrophy, limbs fasciculations and abnormal reflexes; normal tonus/ sensibility. Bulbar/limb electroneuromyography and serum dosage of metals in contact were requested, revealing muscles denervation, axonal diffuse polyneuropathy with postganglionic injury and elevated seric Aluminum (Al), (35,7ug/L). The management was work leave, Nortriptyline, and dietary supplementation. It evolved with reduction in seric Al (3,3ug/L); the physical examination remained unaltered. The condition stabilized after treatment. Discussion: Al exposure causes oxidative stress/neurotoxicity, leading to neuronal degeneration. Axonal sensorimotor neuropathy, progressive asthenia, emaciation, fasciculations, aphasia, ataxia, tongue atrophy, and organs injuries can be found. In this case, the clinical presentation differs from ALS because of sensibility commitment and postganglionic alteration, compatible with chronic axonal neuropathy. Conclusion: Although ALS is the most common MND, atypical cases need further investigation to diagnose and treat correctly.