ORIGINAL RESEARCH PAPER Volume - 10 | Issue - 09 | September - 2021 | PRINT ISSN No. 2277 - 8179 | DOI : 10.

36106/ijsr

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

A CASE REPORT ON CHRONIC ARSENIC POISONING FROM THE SUB-

GANGETIC PLAINS OF BIHAR.

Dermatology
Dr. Kranti Associate professor, Dept. of Skin & VD , Indira Gandhi Institute of Medical sciences
Chandan Jaykar (IGIMS), Patna, Bihar.
Assistant Professor, Department of Forensic Medicine & Toxicology (FMT), Patna
Dr. Ritu Medical College & Hospital (PMCH), Patna, Bihar.
Dr. Himanshi JR III (Acad.), Department of Forensic Medicine & Toxicology (FMT), All India Institute
Narang of Medical Sciences( AIIMS), Patna, Bihar.
Senior resident, Department of Skin & VD, All India Institute of Medical Sciences
Dr. Neha Kumari (AIIMS), Patna, Bihar.
Senior resident, Department of Forensic Medicine & Toxicology (FMT), Vardhman
Dr. Ranvir Ranjan Institute of Medical Sciences (VIMS), Pawapuri; Bihar.
ABSTRACT
Chronic arsenic poisoning is an important public health problem and most notable in sub- Gangetic plains of India, including Uttar Pradesh, Bihar
and West Bengal. As the densely populated Bihar being a known endemic region for arsenicosis hence a very large size of population is exposed to
its adverse effects. The study reported a case from central Bihar where a middle age Hindu male, farmer by occupation from Vaishali district of
Bihar, reported to the dermatology department of a tertiary teaching hospital in Patna with complaints of hyperkeratosis affecting his both palms
and soles for the last 5 years. Considering the ndings of the physical examinations coupled with measured blood and urine arsenic levels, it was
infer that these obvious skin manifestations observed were associated with arsenic exposure. This severe contamination might have occurred
because of the presence of naturally occurring arsenic in groundwater which in turn is determined by various parameters, such as geology, climate,
drainage, topography and soil type. The maximum allowable level for arsenic in drinking water recommended by the World Health Organization is
10 μg/L. Although in this case, it is the arsenic exposure duration which reected the clinical picture, rather than the amount of arsenic ingested.
With the help of health authorities, a survey is needed to be conducted in the village to found the other villagers suffering from similar kind of
illness. Also the level of arsenic in drinking water is to be estimated. There is a need to explore the source of arsenic as well because such
contamination of drinking water can occur naturally or because of human activities or geogenic reasons such as mining.
KEYWORDS
Chronic arsenic poisoning (Arsenicosis), Ground water, hyperkeratosis.
INTRODUCTION arsenic poisoning from a endemic village of central Bihar region. The
Arsenicosis, as dened by the WHO, is “a chronic health condition subjects exhibited classical skin changes of arsenicosis along with
arising from prolonged ingestion of arsenic above the safe dose for at other internal and lab ndings. His symptoms began approximately 6
least 6 months, usually manifested by characteristic skin lesions of months ago, with the chief complaint of insidious onset of numbness
melanosis and keratosis, occurring alone or in combination, with or and tingling in his toes and ngertips, in a symmetric “stocking-glove”
without the involvement of internal organs”. The toxic element, fashion. The dermatological examination reveals signicant
arsenic, is found naturally in groundwater. India prominently gures pigmentation, de-pigmentation and hyperkeratosis over his palms and
amongst the regions of the world with high concentration of arsenic in soles. Apart from the classical skin changes, other signs of multiorgan
earth crust and the state of Bihar being close to the bank of river Ganga, and multisystem involvement such as anemia, leukopenia,
caters most of cases affected by its poisoning. 18 out of 38 districts of hepatomegaly, or elevated liver function tests were also found. The
Bihar, have reported high arsenic content in its groundwater. The patient's past medical history is remarkable for a ulike illness that
problem of arsenic poisoning in ground water of Bihar was reported for occurred few months ago and was characterized by of fever, cough,
the rst time in Simaria Ojhapatti village of Bhojpur district. diarrhea, and myalgias, which resolved spontaneously. The physical
exam demonstrates vital signs, as well as respiratory, cardiovascular,
People may be exposed to arsenic by eating food, drinking water, and abdominal signs, to be within normal limits except hepatomegaly.
breathing air, or by skin contact with soil or water that contains arsenic. There is no lymphadenopathy, ataxia, visual symptoms, or bowel or
Ingestion of low dose via food or water is the main pathway of this bladder involvement.
metalloid into the organism, where absorption takes place in the
stomach and intestines, followed by release into the bloodstream.
Once absorbed, arsenic initially binds to globulin in blood and within
48 hrs. it is redistributed to different organs. Arsenic is a protoplasmic
poison due to its effect on sulfhydryl group of cells interfering with
cells enzymes, cell respiration and mitosis. Medicinal use of arsenic
are also known since long as Fowler's solution in tonic mixtures and in
the treatment of asthma, leukaemia, syphillis, topical eosinophilia,
trepanosomiasis, Lichen planus, verruca planum and psoriasis and
other malignancies. Fig 1:- Clinical appearance of the man with significant raindrop
mottled skin pigmentation and hyperkeratosis over his (i) soles (ii)
The International Agency for Research on Cancer has classied right palm.
arsenic as a group I human carcinogen. Accumulated evidence shows
that long-term exposure to arsenic is associated with cancers of the The pedigree tree of the family showed few other members exhibiting
skin, lung, bladder, liver and kidney. In addition to cancers, it is also arsenic-related skin lesions. Thus, collecting additional urine samples
associated with various non-cancer adverse effects, including skin of the subject's family would be helpful in conrming the diagnosis.
lesions, cardiovascular diseases diabetes, birth defects, abortion and
cognitive impairment. This report elucidates the effects of high levels CONCLUSION:-
of arsenical compounds in the groundwater on the human health. As per history, peripheral neuropathy was be the rst sign to appear in
chronic arsenic toxicity whereas hyperpigmentation and
Case report & Discussion:- The article reported a case of chronic hyperkeratosis were the delayed hallmarks. Mucocutaneous and nail

International Journal of Scientific Research 1

Volume - 10 | Issue - 09 | September - 2021 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

lesions and hepatomegaly were the most signicant ndings. Other

manifestations were characteristic but insignicant. There is no doubt
that malignancies are the most serious health outcomes of arsenic
exposure. Samples of water previously and currently used by the
subject, as well as some groundwater samples near the subject's
residence, should be collected for arsenic analysis. A survey of their
village should be done to nd more cases suffering from similar illness.
The unusual nature of its etiology and the delayed awareness of a
possible toxic exposure may at times challenges the diagnosis. We
hope that this report will raise awareness of the important impacts of
arsenic-based compounds on the human health.

Prevention of arsenic poisoning in humans: Arsenic affected people

are often abandoned by the society, lose their jobs, get divorced or
forced to live a sub-standard life. Melanosis may disappear by using
medicine but keratosis didn't alter, though further complication may be
prevented. No medicine was found effective once complication
developed. The symptoms and signs of arsenic poisoning can only be
reduced if the quality of drinking water were improved. Furthermore, it
was observed that new cases of human poisoning occurred only when
arsenic concentrations in the drinking water source exceeded 0.15
mg/L. Hence, arsenic free water or decrease in arsenic level in the
drinking water source is the only solution for the prevention of
endemic arsenic toxicosis.

Acknowledgement: The author is indebted to all staff of Dept. of skin

&VD and laboratory personnel, and also the staffs of Department of
FMT, who helped the team in this study.

Source of Funding- Self .This article did not receive any specic
grant from funding agencies in the public, commercial, or not-for
prot sectors.

Declaration of Conflict Interest: The authors declare that there is

no conict of interest. Ethical Clearance: Taken from Institutional
Ethical Committee.

Ethical Statements: An informed written consent regarding

publication of this case report was obtained from the subject.

REFERENCES
1. Caussy D, editor. In: A Field Guide for Detection, Management and Surveillance of
Arsenicosis Cases. New Delhi: World Health Organization {WHO}, Regional Ofce of
South – East Asia; 2005.
2. Subrahmanyam BV. Modi's Medical Jurisprudence and Toxicology (Toxicology
Section). 22nd ed. New York city: LexisNexis Butterworth's; 1999. p. 124-5.

2 International Journal of Scientific Research