BACKGROUND: There has been no reported case of arsine poisoning in Korea so far. This article presents the first reported case of arsine poisoning with hemolytic anemia accompanied by acute renal failure. Initially we suspected an infectious agent to be the cause of this case but later discovered that it was arsine poisoning suffered while working at a zinc-smelting industry in the process of recovering the cadmium by-product. We report this case and discuss the arsine poisoning. CASE REPORT: A 27-year-old man employed at a zinc-smelting industry was exposed to arsine while working in the process to recover the cadmium by-product.On the 4th day at work, he had to redissolve defected by-product into a pot and began to experience febrile sensation, diarrhea, upper quadrant abdominal pain, jaundice, and anorexia.After he was admitted to a hospital, the laboratory results showed hemolytic anemia, acute renal failure and elevated concentration of arsenic. He was thus diagnosed as suffering from arsine-poisoning and underwent hem dialysisand supportive therapy.He recovered from the poisoning after51 days and was discharged from the hospital. DISCUSSION: When workers dealing with arsenic-containing material present with hematuria, nausea, vomiting, abdominal pain, and dyspnea followed by hemolysis with acute renal failure, arsine poisoning must be suspected and diagnosis followed by treatment must commence immediately. If any future cases occur, blood and urine samples should be kept in storage so any necessary analysis can be processed later.