A Tale of Three Siblings: A Cluster of Toxic Neuropathy From a Less Suspected Source

Chronic arsenic exposure can affect multiple organ systems, notably the nervous system and hematopoietic tissue. We present three family members (two sisters and a brother) who developed subacute symmetric sensorimotor neuropathy with skin manifestations and anemia. Nerve conduction studies demonstrated axonal sensorimotor polyneuropathy. Urinary arsenic levels were markedly elevated in all three patients. The source of common exposure was found to be over-the-counter homeopathic medication that all three family members were taking. These cases underscore the importance of suspecting arsenic toxicity as a cause of unexplained neuropathy in appropriate settings.