Citation

Zheng J, Zhang K, Liu Y, Wang Y. Forensic Sci. Int. 2019; 300: e24-e30.

Affiliation

Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, China. Electronic address: wangyunyun001@yeah.net.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.forsciint.2019.03.012

PMID

31023496

Abstract

Realgar (arsenic sulfide) is widely used in combination with other herbs as Chinese patent medicine to treat a variety of diseases in China. As a mineral arsenic, its mild toxicity was also well known. Longtime over-dose usage or wrongly oral intake of realgar can cause chronic arsenic poisoning and/or death, but acute fatal arsenic poisoning resulted from short-term dermal use of realgar-containing medicine was very rare. Here, we present the case of a 35-year-old Chinese man, who was diagnosed with severe psoriasis and died of fatal acute arsenic poisoning after he applied a local folk prescription ointment containing mainly the realgar to the affected skin for about 4 days. The autopsy showed multiple punctate hemorrhages over the limbs, pleural effusion, edematous lungs with consolidation, mild myocardial hypertrophy and normal-looking kidneys. The histopathological examination of renal tissue showed severe degeneration, necrosis and desquamation of renal tubular epithelial cells, presence of protein cast and a widened edematous interstitium with interstitial fibrosis. The presence of arsenic in large amount in the ointment (about 6%), in blood (1.76 μg/mL), and in skin (4.71 μg/g), were confirmed analytically. We also provide the clinical records of the deceased and briefly reviewed 7 similar cases in literature (6 in Chinese and 1 in English) in the past 30 years in China.

Copyright © 2019. Published by Elsevier B.V.

Language: en

Keywords

Acute arsenic poisoning; Dermal route; Realgar; Retrospective study