Arsenic intoxication presenting as a myelodysplastic syndrome: A case report

Abstract

A case of arsenic intoxication presenting as a myelodysplastic syndrome is reported. A 41-year-old woman with a 6-month history of gastrointestinal and neurological symptoms was noted to be pancytopenic at presentation. A bone marrow aspirate revealed dysmyelopoietic changes involving all three marrow cell lines. Subsequent analysis of urine for heavy metals demonstrated very high levels of arsenic. Treatment with British anti-Lewisite (BAL) resulted in the resolution of gastrointestinal symptoms and hematological abnormalities although the neurological complications progressed. This case emphasizes that heavy metal intoxication should be considered in the differential diagnosis of any individual presenting with the hematological features of myelodysplasia especially when accompanied by clinical features considered atypical for primary or secondary myelodysplasia.

Association of Clinical Complications with Nutritional Status and the Prevalence of Leukopenia among Arsenic Patients in Bangladesh

“…The magnitude of exposure to patients examined by these researchers is not specified, although arsenic concentration in some of the wells in the area exceeded 1000 µg/L. However, there are reports that hematological effects are not observed in all cases of acute poisoning with arsenic [11,12], and the hematological abnormalities are reversible within weeks of termination of exposure [13].…”

Arsenic Intoxication Presenting with Macrocytosis and Peripheral Neuropathy, without Anemia

“…The peripheral hematologic abnormalities associated with arsenic intoxication include leukopenia, anemia and thrombocytopenia [3][4][5][6][7][8][9], The anemia usually associated with arsenic has normochromic normocytic indices [3,4]. Megaloblastic anemia has been described only rarely [6,7]; however, macrocytosis without anemia associated with peripheral neuropathy, as in our patient, has not been reported previously.…”

“…Chronic arsenic poisoning masquerading as pernicious anemia has been previously reported [5]. In ad dition, a case of chronic arsenic poisoning with megalo blastic anemia has been described, but the patient also had low scrum folate levels [9]. The authors suggest that mega loblastic anemia in this patient was due to the folic acid de ficiency, and that arsenic inhibited the enzymatic conver sion of folic acid into its biologically active derivatives [8].…”

“…Most cases of arsenic intoxication are the result of acci dental or suicidal ingestion of insecticides or pesticides [1], Chronic exposure to arsenic has been associated with multisystemic illness manifested by a variety of signs and symptoms leading to dermatological, gastrointestinal, neurological and hematological disorders [1,[2][3][4][5][6][7][8][9], Hema tological abnormalities include anemia, leukopenia, thrombocytopenia, and frequent basophilic stippling [3][4][5][6][7][8][9], With prolonged exposure to arsenic, the hematolog ical findings may mimic megaloblastic anemia [4][5][6][7][8] and myelodysplastic syndrome [9],…”

Arsenicals

“…Arsenic is known to cause a wide variety of hematological abnormalities like anemia, absolute neutropenia, leucopenia, thrombocytopenia, and relative eosinophilia, which is more common than absolute eosinophilia, basophilic stippling, increased bone marrow vascularity, and rouleaux formation (Rezuke et al, 1991). These effects may be due to a direct hemolytic or cytotoxic effect on the blood cells and a suppression of erythropoiesis.…”