![]() 2 The high content is either due to the practice of deliberately combining herbs with metals, minerals and gems for therapeutic benefit, or due to contamination. 1 Studies have shown that these preparations contain significant amount of heavy metals like arsenic, lead, mercury and cadmium, well above the safety levels. In India ∼80% of the population uses herbal medicine products. (A) Rain drop pigmentation seen over posterior aspect of trunk. The neuropathy stabilized after 6 weeks of onset. Considering a diagnosis of arsenic induced subacute demyelinating polyradiculoneuropathy, he was treated symptomatically for pain. 24-h urine arsenic levels were 405.2 μg/l. ![]() Over the next 2 weeks he developed profound distal weakness, desquamating rash over trunk and limbs, rain drop pigmentation ( Figure 1A) and Mees’ lines ( Figure 1B). Cerebrospinal fluid examination revealed albuminocytologic dissociation. Electrophysiology revealed demyelinating sensorimotor polyradiculoneuropathy with conduction blocks. He had history of intake of indigenous medicines (herbal) during this febrile episode. He had antecedent fever, loose stools, transaminitis, right pleural effusion 2 weeks before the neurological symptoms, which recovered in 5 days. At this time, he noticed imbalance on walking which worsened in dark and some difficulty in gripping objects Examination revealed mild hand grip weakness, generalized areflexia, pansensory loss in glove and stocking distribution and sensory ataxia. The paraesthesias (tingling and gnawing pain) and numbness started distally in hands and feet, almost simultaneously, and reached up till wrists and mid legs over 2 weeks. A 40-year-old male presented with 4 weeks’ history of numbness with painful paraesthesias in limbs.
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