Ten years after becoming international news as the KGB-cum-British spy, taken out by shady Russian operatives using new radioactive poisionings, Alexander Litvinenko has made it back into the (medical) news in a recent case study in the Lancet. His doctors are free to describe his case, now that any state secrets involved have been exposed in court of law. Thus, The Lancet brings us the closest thing I’ve seen in a medical journal to a spy thriller. Alright, perhaps not quite so suspenseful, since we know the tragic outcome from the get-go. Still, a fascinating toxicology tale describing the natural history of Po-210 poisoning. There are interesting parallels to be drawn to the effects of chemotherapy: first nausea and vomiting (though possibly attributed to a potential concomitant C. Diff infection), then alopecia, then bone marrow failure, and finally multiple organ failure and death (Figure 1). The treating physicians note that, at the dosage with which he was poisoned, there was never any hope of his recovery, though they raise the possibility of treatment of lower 210Po doses, and raise interesting questions about hospitals’ ability to recognize cases of this poisoning. A worthy read, both for the sake of geopolitics and for a good primer in radiotoxicology.

Nathwani AC, Down JF, Goldstone J, et al. Polonium-210 poisoning: a first-hand account. Lancet. 2016 Sep 10;388(10049):1075-80. doi: 10.1016/S0140-6736(16)00144-6.