CHRONIC PEDIATRIC ARSENIC POISONING FROM PRESSURE-TREATED WOOD BURNED IN A FIREPLACE

Background: Pressure-treated wood contains copper, chromium, and arsenate (CCA) to prevent decay. Arsenic poisoning from burning pressure-treated wood usually presents with immediate symptomatology. Case: An 11-year-old-male presented with a 6-8 week history of leg cramping, paresthesias, and disabling pain in his feet prior to evaluation. His past medical history was significant for lactose intolerance and chronic sinusitis secondary to a mild IgG subclass deficiency. His medications were Augmentin[R] and guaifesin/pseudoephedrine. There was no patient or family history of pica, vitamin deficiency, metabolic disorders, neuropathy, or illicit drug use. While building an indoor fire alone, the patient unknowingly used pressure-treated wood and was singularly exposed for 10-15 minutes several months prior to his initial medical evaluation. Apparently the damp wood was smoldering and caused smoke to enter the room because the flue was initially closed before the parents realized the problem. Irritability, a gastrointestinal illness, and lower extremity symptoms began 2 weeks after the experience. On his day of presentation, the patient only complained of bilateral pain and tingling of his feet as well as difficulty sleeping and walking secondary to the pain. The patient had normal vital signs. His neurologic examination, which was reportedly normal 2 months earlier when he was evaluated for a minor head contusion after snowboarding, was now significant for bilateral symmetric hyporeflexia, decreased sensation to vibration and position sense of feet, and hypesthesia. Soft tissue swelling was also noted in the dorsum of both feet. No skin changes or nail abnormalities were noted. The patient had normal EMGs of the lower extremities. Laboratory evaluation was normal except for a 24 hour urine total arsenic test of 128 [micro]g/950 mL urine, inorganic fraction was 32 [micro]g/g creatinine ([is less than] 25 [micro]g/g creatinine toxic). Four days after the initiation of succimer therapy, his vibration and position sense normalized but his hypesthesias remained. The patient is still being followed. Conclusions: This case suggests a single exposure to inhalational arsenic can cause significant and persistent toxicity that may be reversible with chelation.
Hahn I, Kline SA, Howland MA, Hoffman RS, Nelson LS. New York City Poison Control Center, St. John's University, New York, NY; Eden Prairie Clinic, Eden Prairie, [...]