As mentioned at the beginning of this article, many questions were raised in our one particular case including the problem of verifying true arsenic toxicity and in determining the source of the exposure. In our case, there was a markedly elevated concentration of arsenic in samples of pubic hair and in the sample of urine. While arsenic toxicity can present with GI symptoms, we felt that in this particular case the association of the abdominal pain with arsenic toxicity was unlikely. For one, the patient's symptoms persisted despite apparent adequate treatment for arsenic toxicity. Also, the usual symptom of chronic arsenic toxicity is peripheral neuropathy (which was not documented in our case) and not abdominal pain. After the exhaustive diagnostic workup, we felt that this patient had irritable bowel syndrome and that the discovery of arsenic toxicity was serendipitous. In regards to the etiology of the toxicity, the patient's occupation involved working in the construction industry for a number of years. He indicated a definite exposure to termite-treated wood throughout that period. Wood for building houses, etc. is commonly pressure-treated with an arsenic-based compound; therefore, this source of occupational exposure appears to be a likely one. Another remotely possible source was the ingestion of contaminated illicit drugs. Cases of the use of illicit drugs laced with various toxic agents such as cyanide and strychnine have been reported. Although our patient required analgesics not commensurate with his symptoms, he categorically denied any use of "street" drugs. The random urine drug screen for such was negative.(ABSTRACT TRUNCATED AT 250 WORDS
