Thallium intoxication with metallic skin discoloration.

A 40-year-old woman was admitted to the hospital with painful paresthesias after drinking brandy and red wine containing thallium. A severe acute axonal sensorimotor neuropathy was diagnosed. She rapidly deteriorated and became comatose within less than a week.1 Metallic skin discoloration and darkening of the cheek and chin areas was observed (figure). Two weeks after thallium ingestion patchy hair loss was noted. She died from multiple organ failure after 25 days in the hospital. Alopecia is the classic sign of thallium poisoning starting 2 to 4 weeks after ingestion.1 Skin changes precede hair loss and are an earlier diagnostic sign.2 The beverages contained large amounts of thallium sulfate and a former friend was later convicted of murder.