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Repeated poisoning of the life partner by thallium — a case of questionable Munchausen by adult proxy syndrome with ensuing attempted murder

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A Correction to this article was published on 09 March 2022

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Abstract

After the use of thallium as rat poison was banned, the knowledge about the severe and treacherous course of poisonings with this toxic metal has widely been lost. In the present case, the male victim sustained two insidious poisoning attacks in 2017 and 2020 by the perpetrator, his female life partner. In the first poisoning episode, he suffered from increasing heavy pain of the abdomen, stinging pain of both legs, persistent obstipation, hyperesthesia, and, after about 2 weeks, tuft-wise loss of hair as typical symptoms of the thallium poisoning. Within 7 weeks, he was successively examined in six hospitals with a wide variety of diagnostic methods, but a conclusive explanation of the complaints was not found. The possibility of a metal intoxication was then suggested by the perpetrator who privately arranged the analysis of a blood sample with the result of 175 µg/l thallium. Although a criminal poisoning was assumed, the perpetrator was not identified. After the victim left the perpetrator, she subtly executed a second poisoning attack with thallium sulfate (blood level 1230 µg/l after 1 day, urine level 4760 µg/l after 10 days, and hair concentrations 3.26–0.49 from proximal to distal in 9 segments). The perpetrator was sentenced to 10.5 years imprisonment for grievous bodily harm and attempted murder. Because of the behavior of the perpetrator, a Munchausen by proxy syndrome was discussed as a motivation of the first poisoning but was excluded by the psychiatric expert because of a missing antisocial personality disorder.

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References

  1. Burton MC, Warren MB, Lapid MI, Bostwick JM (2015) Munchausen syndrome by adult proxy: a review of the literature. J Hosp Med 10(1):32–35

    Article  PubMed  Google Scholar 

  2. Yates G, Bass C (2017) The perpetrators of medical child abuse (Munchausen syndrome by proxy) - a systematic review of 796 cases. Child Abuse Negl 72:45–53

    Article  PubMed  Google Scholar 

  3. Moreno-Ariño M, Bayer A (2017) Munchausen syndrome by proxy-illness fabricated by another in older people. Age Ageing 46(2):166–167

    PubMed  Google Scholar 

  4. Sigal MD, Altmark D, Carmel I (1986) Munchausen syndrome by adult proxy: a perpetrator abusing two adults. J Nerv Ment Dis 174(11):696–698

    Article  CAS  PubMed  Google Scholar 

  5. Sigal M, Altmark D, Gelkopf M (1991) Munchausen syndrome by adult proxy revisited. Isr J Psychiatry Relat Sci 28(1):33–36

    CAS  PubMed  Google Scholar 

  6. Smith NJ, Ardern MH (1989) More in sickness than in health: a case study of Munchausen by proxy in the elderly. J Fam Ther 11(4):321–334

    Article  Google Scholar 

  7. Krebs MO, Bouden A, Lôo H, Olié JP (1996) Munchhausen syndrome by proxy between two adults. Presse Med 25(12):583–586

    CAS  PubMed  Google Scholar 

  8. Ben-Chetrit E, Melmed RN (1998) Recurrent hypoglycaemia in multiple myeloma: a case of Munchausen syndrome by proxy in an elderly patient. J Intern Med 244(2):175–178

    Article  CAS  PubMed  Google Scholar 

  9. Somani VK (1998) Witchcraft’s syndrome: Munchausen’s syndrome by proxy. Int J Dermatol 37:229–230

    Article  CAS  PubMed  Google Scholar 

  10. Chodorowsk Z, Anand JS, Porzezinska B, Markiewicz A (2003) Consciousness disturbances: a case report of Munchausen by proxy syndrome in an elderly patient [in Polish]. Przegl Lek 60(4):307–308

    PubMed  Google Scholar 

  11. Strubel D, Docher C, LaPierre M (2003) Munchhausen syndrome by proxy in an old woman [in French]. Revue Geriatr 28:425–428

    Google Scholar 

  12. Granot R, Berkovic SF, Patterson S, Hopwood M, Mackenzie R (2004) Idiopathic recurrent stupor: a warning. J Neurol Neurosurg Psychiatry 75(3):368–369

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Deimel GW, Burton MC, Raza SS, Lehman JS, Lapid MI, Bostwick JM (2012) Munchausen syndrome by proxy: an adult dyad. Psychosomatics 53(3):294–299

    Article  PubMed  Google Scholar 

  14. Singh A, Coppock M, Mukaetova-Ladinska EB (2013) Munchausen by proxy in older adults: a case report. Maced J Med Sci 6(2):178–181

    Google Scholar 

  15. Moeschlin S (1980) Thallium poisoning. Clin Toxicol 17:133–146

    Article  CAS  PubMed  Google Scholar 

  16. Möschlin S (1986) Klinik und Therapie der Vergiftungen, Georg Thieme Verlag Stuttgart, pp. 140–155.

  17. Kuo HC, Huang CC, Tsai YT, Chu CC, Hsieh ST, Chu NS (2005) Acute painful neuropathy in thallium poisoning. Neurology 65(2):302–304

    Article  PubMed  Google Scholar 

  18. Tsai YT, Huang CC, Kuo HC, Wang HM, Shen WS, Shih TS, Chu NS (2006) Central nervous system effects in acute thallium poisoning. Neurotoxicology 27(2):291–295

    Article  CAS  PubMed  Google Scholar 

  19. Zhao G, Ding M, Zhang B, Lv W, Yin H, Zhang L, Ying Z, Zhang Q (2008) Clinical manifestations and management of acute thallium poisoning. Eur Neurol 60:292–297

    Article  CAS  PubMed  Google Scholar 

  20. Sun TW, Xu QY, Zhang XJ, Wu Q, Liu ZS, Kan QC, Sun CY, Wang L (2012) Management of thallium poisoning in patients with delayed hospital admission. Clin Toxicol (Phila) 50:65–69

    Article  CAS  Google Scholar 

  21. Huang C, Zhang X, Li G, Jiang Y, Wang Q, Tian R (2014) A case of severe thallium poisoning successfully treated with hemoperfusion and continuous veno-venous hemofiltration. Hum Exp Toxicol 33(5):554–558

    Article  CAS  PubMed  Google Scholar 

  22. Zhang HT, Qiao BP, Liu BP, Zhao XG (2014) Study on the treatment of acute thallium poisoning. Am J Med Sci 347:377–381

    Article  PubMed  Google Scholar 

  23. Li S, Huang W, Duan Y, Xing J, Zhou Y (2015) Human fatality due to thallium poisoning: autopsy, microscopy, and mass spectrometry assays. J Forensic Sci 60:247–251

    Article  CAS  PubMed  Google Scholar 

  24. Yang G, Li C, Long Y, Sheng L (2018) Hair loss: evidence to thallium poisoning. Case Rep Emerg Med 1313096. https://doi.org/10.1155/2018/1313096

  25. Lin G, Yuan L, Bai L, Liu Y, Wang Y, Qiu Z (2019) Successful treatment of a patient with severe thallium poisoning in a coma using Prussian blue and plasma exchange: a case report. Medicine (Baltimore). 98(8):e14629

    Article  PubMed  PubMed Central  Google Scholar 

  26. Liu H, Liao G (2021) Long-term misdiagnosis and neurologic outcomes of thallium poisoning: a case report and literature review. Brain Behav. 11(3):e02032

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wang TT, Wen B, Yu XN, Ji ZG, Sun YY, Li Y, Zhu SL, Cao YL, Wang M, Jian XD, Wang T (2021) Early diagnosis, treatment, and outcomes of five patients with acute thallium poisoning. World J Clin Cases 9(19):5082–5091

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pelclová D, Urban P, Ridzon P, Senholdová Z, Lukás E, Diblík P, Lacina L (2009) Two-year fol-low-up of two patients after severe thallium intoxication. Hum Exp Toxicol 28:263–272

    Article  PubMed  Google Scholar 

  29. Senthilkumaran S, Balamurugan N, Jena NN, Menezes RG, Thirumalaikolundusubramanian P (2017) Acute Alopecia: Evidence to Thallium Poisoning. Int J Trichology. 9(1):30–32

    Article  PubMed  PubMed Central  Google Scholar 

  30. Misra UK, Kalita J, Yadav RK, Ranjan P (2003) Thallium poisoning: emphasis on early diagnosis and response to haemodialysis. Postgrad Med J 79(928):103–105

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kalita J, Misra UK (2006) Sequelae of thallium poisoning: clinical and neurophysiological follow-up. Eur Neurol 56(4):253–255

    Article  CAS  PubMed  Google Scholar 

  32. Centers for Disease Control and Prevention (CDC) (2008) Thallium poisoning from eating contaminated cake–Iraq, 2008. MMWR Morb Mortal Wkly Rep 57:1015–1018

    Google Scholar 

  33. Al Hammouri F, Darwazeh G, Said A, Ghosh RA (2011) Acute thallium poisoning: series of ten cases. J Med Toxicol 7(4):306–311

    Article  PubMed  PubMed Central  Google Scholar 

  34. Di Candia D, Muccino E, Battistini A, Boracchi M, Gentile G, Zoja R (2020) Thallium toxicity due to audultered infusion with thallium sulfate in eight members belonging to the same family nucleus: autopsy findings and ICP-MS analysis (inductively coupled plasma mass spectrometry) in a triple homicide. Leg Med (Tokyo). 42:101661

    Article  PubMed  CAS  Google Scholar 

  35. Yumoto T, Tsukahara K, Naito H, Iida A, Nakao A (2017) A successfully treated case of criminal thallium poisoning. J Clin Diagn Res. 11(4):OD01–OD02

    PubMed  PubMed Central  Google Scholar 

  36. Kuroda H, Mukai Y, Nishiyama S, Takeshita T, Tateyama M, Takeda A, Aoki M (2016) Tardily accelerated neurologic deterioration in two-step thallium intoxication. J Clin Neurosci 34:234–236

    Article  CAS  PubMed  Google Scholar 

  37. Zavaliy LB, Petrikov SS, Simonova AY, Potskhveriya MM, Zaker F, Ostapenko YN, Ilyashenko KK, Dikaya TI, Shakhova OB, Evseev AK, Rezaee R, Goroncharovskaya IV (2021) Diagnosis and treatment of persons with acute thallium poisoning. Toxicol Rep 8:277–281

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Rayisyan M, Zakharova N, Babaskina L (2021) Complexions therapy and severe intoxication by Thallium salts. J Environ Sci Health A Tox Hazard Subst Environ Eng 56(4):445–453

    Article  CAS  PubMed  Google Scholar 

  39. Sojáková M, Žigrai M, Karaman A, Plačková S, Klepancová P, Hrušovský Š (2015) Thallium intoxication. Case Report Neuro Endocrinol Lett 36(4):311–315

    PubMed  Google Scholar 

  40. Almassri I, Sekkarie M (2018) Cases of thallium intoxication in Syria: a diagnostic and a therapeutic challenge. Avicenna J Med 8(3):78–81

    Article  PubMed  PubMed Central  Google Scholar 

  41. Riyaz R, Pandalai SL, Schwartz M, Kazzi ZN (2013) A fatal case of thallium toxicity: challenges in management. J Med Toxicol 9(1):75–78

    Article  CAS  PubMed  Google Scholar 

  42. Ash RD, He M (2018) Details of a thallium poisoning case revealed by single hair analysis using laser ablation inductively coupled plasma mass spectrometry. Forensic Sci Int 292:224–231

    Article  CAS  PubMed  Google Scholar 

  43. Pau PW (2000) Management of thallium poisoning. Hong Kong Med J 6(3):316–318

    CAS  PubMed  Google Scholar 

  44. Rusyniak DE, Furbee RB, Kirk MA (2002) Thallium and arsenic poisoning in a small midwestern town. Ann Emerg Med. 39:307–311

    Article  PubMed  Google Scholar 

  45. Arndt T, Jochem G, Stemmerich K (2022) Thallium - von Crookesʼ grünem Zweig zu Christies fahlem Pferd. Toxichem Krimtech 89(1):5–21

    Google Scholar 

  46. Cvjetko P, Cvjetko I, Pavlica M (2010) Thallium toxicity in humans. Arh Hig Rada Toksikol 61(1):111–119

    Article  CAS  PubMed  Google Scholar 

  47. Yu V, Juhász M, Chiang A, Atanaskova Mesinkovska N (2018) Alopecia and associated toxic agents: a systematic review. Skin Appendage Disord 4(4):245–260

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kanwar AJ, Narang T (2013) Anagen effluvium. Indian J Dermatol Venereol Leprol 79(5):604–612

    Article  PubMed  Google Scholar 

  49. Tabandeh H, Thompson GM (1993) Visual function in thallium toxicity. BMJ 307(6899):324

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Heitland P, Köster HD (2021) Human biomonitoring of 73 elements in blood, serum, erythrocytes and urine. J Trace Elem Med Biol. 64:126706

    Article  CAS  PubMed  Google Scholar 

  51. Baselt RC (2014) Disposition of toxic drugs and chemicals in man, 10th edn. Biomedical Publications, Forster City, pp 1961–1964

    Google Scholar 

  52. Heitland P, Köster HD (2006) Biomonitoring of 30 trace elements in urine of children and adults by ICP-MS. Clin Chim Acta 365(1–2):310–318

    Article  CAS  PubMed  Google Scholar 

  53. Campanella B, Onor M, D’Ulivo A, Giannecchini R, D’Orazio M, Petrini R, Bramanti E (2016) Human exposure to thallium through tap water: a study from Valdicastello Carducci and Pietrasanta (northern Tuscany, Italy). Sci Total Environ 548–549:33–42

    Article  PubMed  CAS  Google Scholar 

  54. Aprea MC, Nuvolone D, Petri D, Voller F, Bertelloni S, Aragona I (2020) Human biomonitoring to assess exposure to thallium following the contamination of drinking water. PLoS One 15:e0241223 https://doi.org/10.1371/journal.pone.0241223.

  55. Kijewski H (1993) Die forensische Bedeutung der Mineralstoffgehalte in menschlichen Kopfhaaren. Schmidt-Römhild, Lübeck, pp 113–124

    Google Scholar 

  56. Matsukawa T, Chiba M, Shinohara A, Matsumoto-Omori Y, Yokoyama K (2018) Changes in thallium distribution in the scalp hair after an intoxication incident. Forensic Sci Int 291:230–233

    Article  CAS  PubMed  Google Scholar 

  57. Katz SA (2019) On the use of hair analysis for assessing arsenic intoxication. Int J Environ Res Public Health 16:977–989

    Article  CAS  PubMed Central  Google Scholar 

  58. Poklis A, Saady JJ (1990) Arsenic poisoning: acute or chronic? Suicide or murder? Am J Forensic Med Pathol 11:226–232

    Article  CAS  PubMed  Google Scholar 

  59. Duncan A, Taylor A, Leese E, Allen S, Morton J, McAdam J (2015) Homicidal arsenic poisoning. Ann Clin Biochem 52:510–515

    Article  PubMed  Google Scholar 

  60. Bundesamt für Verbraucherschutz und Lebensmittelsicherheit. Informationen über zugelassene Pflanzenschutzmittel. Beendete Zulassungen von Pflanzenschutzmitteln (Stand Januar 2021); https://www.bvl.bund.de/SharedDocs/Downloads/04_Pflanzenschutzmittel/Beendete_PSM.html?nn=11031326 (accessed 26.01.2022).

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Acknowledgements

The authors thank Dr. Peter Heitland and Dr. Helmut D. Köster (Medical Laboratory Bremen) for the determination of the thallium concentrations in blood, urine, and hair and Dr. Kristian Wittke (Police Office of Criminal Investigations Berlin) for the analytical investigation of the sized substances.

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  1. Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Forensic Medicine, Turmstraße 21 (Haus N), 10559, Berlin, Germany

    Fritz Pragst & Sven Hartwig

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The original online version of this article was revised: The original article contain an error. In page 3, Table 1: The line in the middle of the Table must be removed. In page 6, left column, line 7: reference citation [17] must be replaced by [60].

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Pragst, F., Hartwig, S. Repeated poisoning of the life partner by thallium — a case of questionable Munchausen by adult proxy syndrome with ensuing attempted murder. Int J Legal Med 136, 695–704 (2022). https://doi.org/10.1007/s00414-022-02791-4

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