Long-term misdiagnosis and neurologic outcomes of thallium poisoning: A case report and literature review.

INTRODUCTION: Thallium poisoning is a rare occurrence. Therefore, thallium poisoning is easily misdiagnosed and is often accompanied by a series of serious sequelae and can even result in death in severe cases. Here, we report long-term follow-up of a case of a patient who was poisoned with thallium on two separate occasions.
METHODS: A 43-year-old man was initially misdiagnosed as gastroenteritis, diabetic peripheral neuropathy, and Guillain-Barré Syndrome (GBS) within 21 months. The correct diagnosis was confirmed by blood and urine thallium assays. After Prussian blue treatment, thallium was undetectable in the blood by day 60. Following this investigation, a criminal suspect confessed to two instances of adulterating thallium sulfate in the patient's beverage. A 6-year follow-up was performed after discharge, and a comprehensive literature was review.
RESULTS: We found that the original gastrointestinal symptoms, skin lesions, and hair loss were reversed and had recovered, except for residual neurologic damage, even with long-term rehabilitation. DISCUSSION: Thallium intoxication may have been initially identified if neurologic symptoms had occurred concurrently with gastrointestinal and cutaneous symptoms. Neurologic damage represented the main sequelae of thallium poisoning in our present case report.