Aluminum, is the third most common element in the earth and has a significant toxic effects for humans. Although Al toxicity has been generally reported in dialysis population, it has been demonstrated elevated concentrations of Al was also toxic to non-dialyzed individuals, especially who is working in metal industry. Al toxicity mainly affects nervous system, musculoskeletal system, hematopoietic system and endocrine system. We presented a case who had severe weight loss, memory impairment and had a history of drinking well water. Complete blood count elicited normocytic anemia and other laboratory results proved low basal cortisol level. The toxicological analysis of water and patients blood sample revealed high Al level, we started desferrioxamine chelation and hydrocortisone replacement. After six month-therapy, anemia ameliorated and cognitive dysfunction was improved. Al toxicity should be thought as a possible diagnosis when a patient presents with unexplained anemia, weight loss, early onset dementia or personality changes.
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