Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5082
Peer-review started: February 6, 2021
First decision: March 25, 2021
Revised: March 27, 2021
Accepted: May 17, 2021
Article in press: May 17, 2021
Published online: July 6, 2021
Processing time: 138 Days and 2.8 Hours
Thallium poisoning is rare and difficult to recognize. Early diagnosis and treatment of thallium-poisoned patients are essential to prevent morbidity and mortality.
To evaluate the efficacy of treatments and outcomes of five patients with early diagnosis of acute thallium poisoning.
Five patients who consumed a thallium-contaminated meal were hospitalized in succession, and underwent clinical examinations such as blood tests and electromyography tests. Urine and blood tests confirmed the diagnosis of thallotoxicosis, revealing the occurrence of food poisoning. All patients underwent detoxification treatment, including hemoperfusion (HP) and treatment with Prussian blue (PB). A 24-mo follow-up was performed to evaluate the long-term outcomes on the patients after discharge.
Initially, the patients presented with symptoms of acute thallium poisoning including hyperalgesia of the limbs and abdominalgia, which may differ from common peripheral neuropathy. Accompanying symptoms such as hepatic damage and alopecia were observed in all the patients, which further confirmed the diagnosis of poisoning. Treatment with chelating agents was ineffective, while HP and treatment with PB drastically decreased the thallium concentration in the urine and blood. With early diagnosis and intervention, four patients had a good prognosis and no permanent sequelae. One patient developed blindness and disability during the 24-mo follow-up period.
Identification of incident cluster and characteristic symptoms is extremely important for early diagnosis of acute thallium poisoning. HP plus PB is essential to improve the prognosis of thallium-poisoned patients.
Core Tip: Thallium poisoning is rare and easily to be misdiagnosed. In this study, dysesthesia of limbs, hyperalgesia, and abdominalgia were the main initial symptoms of the five patients who had a thallium-contaminating meal together. The diagnosis was confirmed by high thallium concentrations in the blood and urine samples which were detected 8 to 12 d after exposure. We found that early treatment with the combination of hemoperfusion and Prussian blue significantly decreased the concentration of thallium in the body and improved the prognosis. Our study provided valuable experiences on early diagnosis and therapeutic regimen for thallium-poisoned patients.