Outbreak of thallium poisoning among Iraqi patients

Background: Thallium is the most suitable agent for criminal poisoning of human beings as it is tasteless and odorless. It is usually associated with typical clinical features, mainly dermatological and neurological manifestations. Objective: To report an outbreak of thallium poisoning in Iraq and to review the literatures. Patients and methods: This descriptive study was conducted in the Department of Dermatology- Baghdad Teaching Hospital from February 2008 to April 2008. Twenty-two patients with thallium poisoning were seen in the Poisoning Consultation Center during this period and thallium in urine has been measured using the colorimetric method and was positive in all of them. We had the opportunity to see five cases referred for skin manifestations. Detailed history was done regarding all demographics points related to this poisoning. Full clinical examination was performed looking for skin manifestations, and other systemic involvements were also assessed. Results: Five male patients with thallium poisoning were evaluated. Their ages ranged from 10 to 32 years with a mean of 24 years. All patients gave history of eating cakes laced with thallium. The dermatological findings were mainly anagen hair loss in diffuse and patchy pattern which affected the scalp and limbs. Also dusk ecchymotic red rash dermatitis-like picture was observed on the face, especially perioral region and dorsum of hands and legs. Neurological manifestations consisted of mainly peripheral neuropathy and muscular weakness was also recorded. Psychiatric findings were also observed, mainly depression and apathy. Conclusion: Outbreak of thallium poisoning is now occurring in Iraq killing many people mainly for political reasons. It gives characteristic cutaneous, neurological and psychological features that can lead to the right diagnosis.