Arsenic poisoning and Mees' lines.
A 40 year old male presented with 4 weeks' history of numbness with painful paraesthesias in limbs. 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. 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. He had antecedent fever, loose stools, transaminitis, right pleural effusion 2 weeks before the
QJM monthly journal of the Association of Physicians