Polyneuropathies due to toxins continue to pose a challenge to the medical profession. Early suspicion of the condition, correct identification of the toxin and timely institution of therapy is not only life saving but can also greatly reduce the morbidity burden of the condition. We report six cases (2 females, 4 males) belonging to the same family and presenting with similar features of an acute to subacute onset, symmetrical, predominantly distal, graded, painful, sensori-motor polyneuropathy. All these patients complained of recurrent episodes of vomiting which started within 30 minutes to two hours of ingestion of home cooked vegetarian meal. After a variable period of 2–7 days the symptoms of polyneuropathy appeared. Electrophysiological studies demonstrated an axonal type of sensori-motor polyneuropathy. The temporal onset of symptoms, involvement of several individuals at the same time and a consistent and similar pattern of clinical findings were features highly suggestive of a toxin etiology. Using a structured and a logical approach in the background of the characteristic clinical picture the diagnostic possibilities were significantly narrowed down. Since the patients presented late and due to financial and technical constraints all tests could not be performed the toxin could not be confirmed.

doi: 10.5214/ans.0972.7531.2007.140405