Acute arsenic intoxication is a rare cause of an acute demyelinating p01yneuropathy.l~~~ The clinical features include a multisystem illness with an acute gastroenteritis, pancytopenia, pleural effusions, peripheral edema, especially facial swelling, and cardiac arrhythmias, especially torsades de pointes. An acute or subacute demyelinating polyneuropathy beginning 1-3 weeks following exposure has been described, in contrast to the distal axonal, predominantly sensory polyneuropathy associated with chronic low-level arsenic exposure.' The acute neuropathy is usually initially misdiagnosed as Guillain-Barrk syndrome (GBS) with electrophysiological and spinal fluid examinations supportive of GBS. In the case reported here, partial response to immunosuppressant therapy occurred, further contributing to a mistaken initial diagnosis.
CASE REPORT
A 34year-old Chinese-American woman developed acute nausea, vomiting, frontal headache, dry cough, and swollen face and eyes, followed within 1 week by wheezing and several syncopal episodes. She developed a ventricular arrythmia, torsades de point, and was found to have a pericardial effusion, bilateral pleural effusions, and pancytopenia [ hematocrit (HCT) 25, while blood cell count (WBC) 1.8, platelet count 77 Kl.
Sixteen days after the initial onset of her protracted vomiting, she developed severe burning pain, numbness, and swelling in the hands and feet; marked impairment in grip strength; and difficulty walking, with pain and inability to feel the floor with