Trust your gut: a case of persistent gastrointestinal disturbances

Abstract Arsenic is found ubiquitously throughout the environment and exists as inorganic (toxic) or organic (nontoxic) forms. Humans can be exposed to arsenic through various sources, including through the diet. Rice and rice-based foods are known to contain high concentrations of inorganic arsenic. We report a case of a 22-year-old female who was evaluated for severe gastrointestinal complaints, with unremarkable abdominal imaging and largely equivocal laboratory findings. However, urine heavy metal test results revealed elevated total arsenic concentrations. Upon arsenic speciation, it was determined that inorganic arsenic was the predominant species found in the patient’s urine. This elevated inorganic arsenic concentration was likely attributed to the rice-rich diet followed by the patient. Eliminating the source of arsenic exposure along with symptom-based treatment led to the overall improvement of the patient’s health. This case highlights the value of heavy metal screening in investigating differential diagnoses.