When Hair Loss is No Laughing Matter? It Could Kill, Literally!
By Dr Khoo Lee Seng
Many people view hair loss as innocuous part and parcel of aging. Some men who undergo hair transplant surgery or with Minoxidil & Finasteride medication are seen as vain pots. Men such as Donald Trump and Bobby Charlton attempt the comb over to hide their balding to become embarrassing internet me-mes.
But what if I tell you hair loss can be deadly is the cause isn't picked up by your doctor?
The following case is no fiction and where hair loss can kill, literally.
A 25 year old man was referred over to the skin specialist with sudden diffuse hair loss. His hair loss was so severe that gentle tug over remaining hair resulted in painless extraction of over tufts of 50 hair follicles.
On examination, he had a rapid pulse (Heart Rate 125 beats/minute). He had high blood pressure (180/110 mm Hg). He had a normal brain MRI and spinal tap.
On further questioning, this gentleman reveals that he is a teacher, married, no children and he says his marriage is pretty rocky. They are arguing all the time.
However, he was actually concerned more about his sudden hair loss which he attributes to life stressor. On closer microscopic examination , his hair shafts were in a state of anagen effluvium which is hair shedding during anagen (normal growing hairs not resting hairs). Normally this only happens when patients are placed on chemotherapy or are exposed to heavy metals (lead, arsenic etc).
He is losing growing hair and this was an extreme example.
When you hear hoofbeats, do you think Horses or Zebras?
The emergency room (ER) doctors and neurologists were clueless as to what was his diagnosis.
What's happening to him? What is suggested by this symptom set?
So, he has a rocky marriage and he has these other signs and symptoms. Remember that heavy metal poisoning is associated with neuropathy and eye abnormalities. When you throw is the tachycardia (rapid pulse) and hypertension (high blood pressure), you have a constellation of symptoms associated with heavy metal thalium poisoning which a seasoned doctor can detect.
It was kind of hard to say, "Is your spouse trying to kill you?".
You would have to have some sort of basis to start that. And of course she is at the bedside and being solicitous asking "Oh, what's wrong with my husband and why he has lost all his hair etc"
So, a urine sample for Thallium was sent and there behold, this gentleman was being poisoned with Thallium. As events later unfold , it is revealed that the wife got the radionuclide Thallium online from India and she was trying to kill him.
Thallium sulfate is colorless, odorless and can be easily dissolved in water and comes close to a perfect poison! In the past, Thallium was popular as a rat poison.
The murder mystery writer Agatha Christie has been implicated in bringing Thallium to the attention to many would be poisoners in her 1961 novel, The Pale Horse of which she wrote about attributing the poisonous effect of Thallium to black magic.
Unbelievable!
The wife was found guilty of attempted murder, and this case was tried in Texas where the District Attorney pressed the charge of "attempted murder with a deadly weapon" as she wanted the jury to take into account the very deadly weapon which was of course the heavy metal Thallium. She was sentenced to 20 years behind bars.
As for the husband? He made an uneventful full recovery after treatment with Prussian blue and now has a full head of hair again (and is married again). Who says there are no happy endings?
The above case was recounted by Theodore Rosen MD , a dermatologist from the Baylor College of Medicine where he was also called to testify in this attempted homicide case.
REFERENCES
(1) Yumoto, T. (2017). A Successfully Treated Case of Criminal Thallium Poisoning. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH.
(2) Senthilkumaran, S., Balamurugan, N., Jena, N.N., Menezes, R.G. and Thirumalaikolundusubramanian, P. (2017). Acute Alopecia: Evidence to Thallium Poisoning. International Journal of Trichology, 9(1), pp.30–32.
(3) Yang, G., Li, C., Long, Y. and Sheng, L. (2018). Hair Loss: Evidence to Thallium Poisoning. [online] Case Reports in Emergency Medicine
(4) Campbell, C., Bahrami, S. and Owen, C. (2016). Anagen Effluvium Caused by Thallium Poisoning. JAMA Dermatology, [online] 152(6), pp.724–726.
Sincerely Yours,
Dr Khoo Lee Seng
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