THALLIUM POISONING FROM MALICIOUSLY CONTAMINATED FOOD

Four young adults presented two days after one of them had received ma rzipan balls packaged in a box from an expensive candy manufacturer. T wo ate one candy ball, while two others shared a third. The next day, variable gastrointestinal symptoms developed. On the third day, two pa tients developed painful paresthesiae of the hands and feet, an early but nonspecific clinical marker of thallium poisoning. A tentative dia gnosis of thallium poisoning was made based on symptoms, and treatment was initiated. The remaining candies were radiographed. Metallic dens ities in the candies supported the diagnosis, and atomic absorption sp ectroscopy was used to quantitate thallium content. Each candy contain ed a potentially fatal dose. Five to seven days later, hypertension an d tachycardia developed in the two patients who had ingested an entire candy. All patients developed alopecia but recovered without overt ne urologic or other sequelae. While the diagnosis of thallium poisoning is often delayed until alopecia develops, an early diagnosis favors an effective treatment strategy.