Acute copper sulfate poisoning resulting from dermal absorption

We report a Korean worker who experienced dermal exposure to a hot copper sulfate solution at his workplace and developed severe acute copper sulfate poisoning. A 53-year-old male worker, who was employed in a lead smelter for 5 years, slipped, and his right lower leg entered a copper sulfate solution, leading to severe burns of the right lower leg. Two days later, he developed severe intravascular hemolysis with methemoglobinemia. He also suffered from acute kidney injury, had an asymptomatic cerebral ischemic stroke, and melena due to multiple shallow gastric ulcers. His serum copper level was mildly elevated (153.6 μg/dL, reference: 64.0-134 μg/dL). He was transfused with red blood cell concentrate and supported by hemodialysis. After 13 sessions of hemodialysis and several blood transfusions, he completely recovered. Most previously reported incidents of severe acute copper sulfate poisoning were from accidental or suicidal oral intake. There are few previous reports of systemic copper sulfate toxicity following exposure through burned skin.