A Guillain‐Barré Syndrome‐like Neuropathy Associated with Arsenic Exposure

Abstract

Republic of Korea-Objectives:We report on a patient presenting with an isolated polyneuropathy mimicking Guillain-Barré syndrome (GBS) associated with arsenic exposure. Case: A 43-year-old man visited our emergency room complaining of progressive quadriparesis over the prior 5 days. His clinical course with laboratory data was typical of GBS. However, because of his recent use of herbal medication, we screened for the presence of several heavy metals. Serial analyses of urinary inorganic arsenic concentrations confirmed exposure to arsenic. He was diagnosed as arsenic neuropathy mimicking GBS without any systemic manifestation of arsenic intoxication. Conclusions: The present case study emphasizes the need to consider arsenic intoxication in patients presenting with acute demyelinating neuropathies and histories of herbal medication use. (J Occup Health 2012; 54: 344-347) Key words: Arsenic, Guillain-Barré syndrome, Peripheral neuropathy, SpeciesAcute arsenic intoxication is a rare cause of acute demyelinating polyneuropathy 1) . The earliest clinical features of acute, high-dose arsenic poisoning

Reversibility of changes in brain cholinergic receptors and acetylcholinesterase activity in rats following early life arsenic exposure

“…While chronic arsenic poisoning affects the functioning of respiratory, cardiovascular, gastro-intestinal, genito-urinary and endocrine systems in humans, the nervous system is more vulnerable to its toxic effects (Borenstein et al, 2006;Dauphine et al, 2011;Abhyankar et al, 2012). It has been found that arsenic may affect both the central and peripheral nervous systems causing subclinical to clinical effects (Navas-Acien et al, 2006;Kim et al, 2013). Epidemiological studies have revealed an association between arsenic in drinking water and the risk of cognitive impairment including disturbed visual perception and visuomotor integration, psychomotor speed, attention, speech and memory (Calderon et al, 2001;Rodriguez et al, 2003;Tsai et al, 2003).…”

Lead Poisoning Can Be Misdiagnosed as Guillain-barre Syndrome: A Case Report

“…The most common sign of LP in adults is peripheral neuropathy [2]. It has been shown that acute neuropathy is initially misdiagnosed as GBS [6]. To identify the potential sources of lead exposure, taking a medical and environmental history, looking for signs on physical examination, and confirming excessive lead exposure or organ system damage looking for laboratory evidence are required [7].…”

Chronic arsenic intoxication diagnostic score (CAsIDS)

“…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, ).…”

“…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).…”