Skin Manifestations in Acute Arsenic Poisoning From the Wakayama Curry-Poisoning Incident

K. Uede, F. Furukawa

Disclosures

The British Journal of Dermatology. 2003;149(4) 

In This Article

Patients and Methods

On 25 July 1998, a summer festival was held at about 18·00 h in the Sonobe district of Wakayama City, Japan. About 100 people from 70 families in this small community attended the festival. Volunteers had set up food stalls, and light meals were prepared. The curry was served from three large pots by neighbourhood housewives. Within 30 min, 67 people who ate the curry and rice, ranging in age from 1 to 68 years, including four pregnant women, developed profuse nausea and vomiting. They were brought to 13 hospitals, and 45 patients were admitted. By the next morning, four of them had died of acute circulatory failure. Their main symptoms and signs were nausea, vomiting, abdominal pain, headache and hypotension. The chief laboratory findings were hypopotassaemia, abnormal peripheral blood leucocyte counts, liver dysfunction and abnormal electrocardiogram findings ( Table 1 ). On the following day, the police reported that cyanide had been detected in the vomit. About half of the victims were then treated with sodium thiosulphate. After 1 week, the police reported that arsenic trioxide had been detected in the curry. The predicted oral doses of arsenic trioxide ranged from 22 to 205 mg (mean ± SD 75·1 ± 36·7). Finally, it was estimated that about 135 g of arsenic had been added to a pot of curry, enough to kill up to 1170 people. As 1 week had already passed since the poisoning, the patients were not treated with dimercaprol, an antidote to arsenic.

Four of the 67 patients with arsenic poisoning died, and the remaining 63 patients served as subjects for this study. The dermatological findings were gathered through the clinical and histopathological findings in six patients with skin lesions who were admitted to institutions with full-time dermatologists, by reviewing the medical charts from other institutions where the remaining 39 patients were admitted, by dermatological examination of 21 patients, and by a medical inquiry at health screenings for 63 victims conducted 3 months after the incident.

processing....