Chronic Arsenic Toxicity Without Classical Cutaneous Manifestations: A Case Report

Chronic arsenic toxicity can present with gastrointestinal and neurological symptoms, and diagnosis is often difficult without characteristic cutaneous features. This report describes a 55-year-old woman with a three-month history of progressively worsening small bowel-type diarrhea that progressed to frequent episodes of melena. She developed painful stocking-distribution peripheral neuropathy with slipper slippage, followed by progressive lower-limb weakness that ultimately resulted in loss of ambulation. She had a seven-year history of unsupervised use of herbal preparations and Ayurvedic Bhasma. Despite comprehensive evaluation, the diagnosis remained unclear because classical cutaneous signs of chronic arsenicosis were absent. A thorough medication history led to heavy metal screening (urinary arsenic level), which confirmed arsenic toxicity. Discontinuation of the suspected herbal preparations and supportive care, without chelation therapy, resulted in complete resolution of gastrointestinal symptoms and anemia, gradual neurological recovery, and restoration of independent ambulation. This case highlights the need to consider chronic arsenic toxicity in patients with unexplained chronic diarrhea and painful peripheral neuropathy, even when characteristic skin findings are absent. A detailed inquiry into the use of complementary and alternative medicine is crucial, as early identification and removal of the source of exposure can facilitate significant clinical recovery.