Osteoresorptive arsenic intoxication.

Area of Science:

• Toxicology
• Endocrinology
• Dermatology

Background:

• A 47-year-old woman presented with widespread dermatitis, urticaria, and foot blisters.
• She had a history of hypopigmented skin spots since early adulthood and experienced a myocardial infarction and breast cancer diagnosis.
• Further investigations revealed Hashimoto thyroiditis, vitamin D insufficiency, secondary hyperparathyroidism, and complex anemia.

Observation:

• Laboratory results indicated osteoporosis with elevated urinary Dipyridinolin-crosslinks (u-Dpd).
• Significantly high urinary arsenic (u-As) levels were detected (500μg/l).
• Other potential causes for anemia and bone disease, including thalassemia and iron deficiency, were ruled out.

Findings:

• The patient was diagnosed with osteoresorptive arsenic intoxication (ORAI).
• Treatment involved oral vitamin D and calcium supplementation, alongside intravenous zolendronate therapy.
• This regimen normalized u-Dpd levels, significantly reduced urinary arsenic, and resolved anemia and urticaria.

Implications:

• This case highlights arsenic intoxication as a critical, yet often overlooked, cause of severe bone resorption and multi-systemic illness.
• Early diagnosis and targeted treatment, including chelation or supportive therapies, are crucial for managing ORAI.
• The findings underscore the importance of considering environmental and toxicological factors in complex, unexplained medical conditions.