J Yeungnam Med Sci.  2023 Jul;40(3):311-314. 10.12701/jyms.2022.00647.

Thallium poisoning: a case report

• Jimenez O
• Cáceres H
• Gimenez L
• Soto L
• Montenegro M
• Rueda JAA

• KMID: 2544595
• DOI: http://doi.org/10.12701/jyms.2022.00647

Abstract

Thallium poisoning is usually accidental. We present a case of a 51-year-old woman who was evaluated in June 2018 for myalgia, vertigo, asthenia, and abdominal pain. Physical examination revealed temporal-spatial disorientation, jaundice, and asterixis. The laboratory reported the following: bilirubin, 10.3 mg/dL; aspartate transaminase, 78 U/L; alanine transaminase, 194 U/L; albumin, 2.3 g/dL; prothrombin time, 40%; and platelet count, 60,000/mm3. Serology performed for hepatitis A, B, and C; Epstein-Barr virus; cytomegalovirus; and human immunodeficiency virus was negative, and a collagenogram was negative. Physical reevaluation revealed alopecia on the scalp, armpits, and eyebrows; macules on the face; plantar hyperkeratosis; and ulcers on the lower limbs. Tests for lead, arsenic, copper, and mercury were carried out, which were normal; however, elevated urinary thallium (540 µg/g; range, 0.4–10 µg/g) was observed. The patient was treated with ᴅ-penicillamine 1,000 mg/day and recovered her urinary thallium levels were within normal range at annual follow-up. Thallium poisoning is extremely rare and can be fatal in small doses. An adequate clinical approach can facilitate early diagnosis.

Keyword

Alopecia; Intoxication; Liver failure; Thallium

Figure

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  Fig. 1. Alopecia of (A) the scalp and (B) eyebrows.

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  Fig. 2. (A) Plantar hyperkeratosis and (B) ulcers in the lower limbs.

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