A difficult case with proteinuria and progressive tremor

In this paper, we report a case of interstitial nephritis with proteinuria, neurological manifestations, and uncontrollable blood pressure following chronic thallium poisoning .A 20 years old girl which after a headache, mild hair loss tremor in the upper extremity, high blood pressure and CKD 3 (serum creatinine 1.8mg/dl) and proteinuria +� in kidney biopsy sever chronic interstitial nephritis with glomerulosclerosis repored) has been hospitalized about 1.5 years ago. In the preliminary studies, she has been diagnosed and treated for Wilson’s disease. Although Next study disproved this diagnosis. She has been routinely treated with corticosteroids and antihypertensive drugs(ACE & diuretic & beta blocker). However, due to the lack of favorable response to the increase creatinine to 2mg/dl, and the exacerbation of tremor and hypertension , she has been exterminated for the possibility of a genetic disease which was also disproved. Eventually, study of the patient’s case history led us to Heavy metals poisoning which has been confirmed by a urine and blood test for thallium . The special treatment has been started for one month and the patient’s contacts were eliminated as much as possible. After a month of treatment, the patient’s creatinine was 1.4 and 1+ proteins in urin , while the tremor was incredibly small. Moreover, the patient’s blood pressure, which was previously uncontrollable, has been reached 135/85. Thallium is a heavy metal odorless and tasteless, it has successfully been used worldwide as a rat poison and ant killer. Because chronic thallium exposure mimics other disease many cases of industrial thallium exposure most likely go unnoticed. . Occupational history is important but the patient may not know that he or she has been exposed. On the other hand, accidental poisoning caused by direct contact with and careless handling of thallium-ontaining materials occurs more frequently• Thallium is toxic by cumulative intake; it can be absorbed through the skin, respiratory, and GI tracts. Therefore, besides oral ingestion, inhalation of contaminated dust during manufacture, sniffing what was thought to be cocaine, and skin absorption through protective gloves have all been reported as causes of thallium toxicity. In addition, cases of thallium intoxication by intravenous injection of contaminated heroin have been reported. However, the vast majority of cases result from oral exposures.• In Iran, the most common form of poisoning is exposure to insecticide poisons containing thallium.In Europe and the United States, thallium sulfate was banned from import, export, possession and uses as an agricultural pesticide long ago. Several factors led to its ban, e.g. the invisible traits which makes it easy to be misused, pollutant’s effect on non-target toxicity and harming the environment. Given the severe toxicity high chance of human, contamination and its irreparable environmental hazards, we recommend the total removal of this toxic substance.