Images in Dermatology: Chronic Groundwater Arsenic Poisoning: Clinical Insights from a Patient from Murshidabad District

Volume 3 Issue 1 (Jul-Dec) 2025 Images in Dermatology (1) Articles in The ESRF Research Journal for Undergraduate Medical Students are Open Access articles published under a Creative Commons Attribution-Non Commercial 4.0 International License (CC BY-NC). This license permits use, distribution, and reproduction in any medium, provided the original work is properly cited, but it cannot be used for commercial purposes and it cannot be changed in any way. Published by: Eureka Scientech Research Foundation, Kolkata. Online access: https://esrfrjums.co.in Images in Dermatology: Chronic Groundwater Arsenic Poisoning: Clinical Insights from a Patient from Murshidabad District DOI: 10.5281/ zenodo.17360706 Available from: https:// esrfrjums.co.in/index.php/main/ article/view/82 Adityendu Chakraborty1, Arun Achar2. Monika Kumari1 1Post Graduate Trainee, Dermatology, Nil Ratan Sircar Medical College, Kolkata 2Professor and Head, Dermatology, Nil Ratan Sircar Medical College, Kolkata CASE 1 A 50-year-old farmer from Murshidabad, presented with numerous hyperpigmented and hypopigmented areas particularly affecting the trunk, neck, and limbs. Thickened skin lesions, including papules and plaques were seen on palm and soles. Systemic examination showed mild hepatomegaly confirmed on ultrasonography. Laboratory investigation revealed mild anemia and a normal differential count. Liver Function Tests were slightly deranged. Since Murshidabad is one of the districts affected by arsenic contamination of groundwater, a differential diagnosis of chronic arsenicosis was made based on the clinical presentations. A skin biopsy revealed hyperkeratosis, parakeratosis, dyskeratosis, basal cell degeneration, and melanin incontinence and dense lymphocytic infiltrate in dermoepidermal junction, suggestive of arsenical keratosis. In addition, analysis of drinking water from the tube well used by the patient and family members revealed arsenic concentration of 0.08 mg/L in drinking water (WHO permissible limit = 0.01 mg/L). Arsenic levels in patients’ hair and nails were 0.9 μg/gm (permissible limit = 0.8 μg/gm) and 1.4 μg/ gm (permissible limit=1.3 μg/gm) respectively. Therefore, a final diagnosis of chronic arsenic poisoning (arsenicosis) was confirmed, based on clinical signs, biopsy findings, history of groundwater consumption, and findings of high arsenic levels in the water supply. Corresponding Author Dr. Adityendu Chakraborty Room number 16A, NHQ Doctor’s hostel, Nil Ratan Sircar Medical College, Kolkata—14 E-mail: adityenduchakrabort- [email protected]m Figure 1: Raindrop pigmentation over back Figure 2: Palmar hyperkeratosis Volume 3, Issue 1 (Jul-Dec), 2025 (2) Articles in The ESRF Research Journal for Undergraduate Medical Students are Open Access articles published under a Creative Commons Attribution-Non Commercial 4.0 International License (CC BY-NC). This license permits use, distribution, and reproduction in any medium, provided the original work is properly cited, but it cannot be used for commercial purposes and it cannot be changed in any way. Images in Dermatology Figure 3: Raindrop pigmentation and arsenical keratosis over chest Figure 4: Histopathological image shows arsenical keratosis Declaration of patient consent: Appropriate patient consent was obtained by the authors for taking and sharing pictures. Chronic Groundwater Arsenic Poisoning: Clinical Insights