IMAGES IN MEDICINE
Iatrogenic arsenic induced Mees’ lines
1 Department of Neurology and Neurosurgery, University of Pittsburgh Medical School, Pittsburgh, USA
2 National Institutes of Health, Bethesda, USA
3 Department of Internal Medicine, Georgetown University Hospital, Washington, USA
4 Department of Neurology, Georgetown University Hospital
Correspondence to:
Correspondence to:
Dr V Lupu
EMG Section, NINDS, NIH, Building 10, CRC, Room 7-5680, 10 Center Drive, MSC-1404, Bethesda, MD 20892-1404, USA; lupuv@ninds.nih.gov
Keywords: chemotherapy; acute myeloid leukaemia; nails; adverse drug reaction; leuconychia
| The first 150 words of the full text of this article appear below. |
A 43 year old white man, with acute myeloid leukaemia, resistant to induction (cytarabine + daunorubicin) and reinduction chemotherapy (cytarabine + daunorubicin + etoposide), accepted "a last resort" treatment with arsenic trioxide (0.15 mg/kg/day, intravenously; 14 mg/day). Arsenic treatment was started four weeks after reinduction chemotherapy. Before beginning arsenic treatment, the patient was in a poor general condition and suffered from a motor peripheral neuropathy because of chemotherapy. On the seventh day of his treatment, after having received 84 mg of arsenic, a Mees’ line was first noted on the right middle fingernail.1–3 Within 10 days Mees’ lines became visible on other fingers of the right hand and within 14 days on the left fingernails. The picture was taken 18 days after the start of treatment, by which time he had received a total of 266 mg of arsenic. Blood concentrations of arsenic were not monitored. The patient continued to
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