Chronic Mercury Intoxication Masquerading as Systemic Disease: A Case Report and Review of the Literature
KeywordsMercury, Chronic Intoxication, Heavy Metal, Inflammatory disease
Background: Mercury is a highly toxic environmental metal that exists in three different forms: elemental, inorganic and organic. Intoxication occurs in either occupational or non-occupational settings, mainly after the inhalation of vapour and fumes in work places, laboratories or homes. Chronic mercury toxicity ranges from mild and insignificant to severe and life-threatening. We describe the case of a young male patient who presented with multiple organ dysfunction after chronic mercury exposure.
Case presentation: We report the case of 28-year-old male artisanal gold miner who was admitted to hospital for severe neurological impairment associated with inflammatory bowel disease-like symptoms and a skin rash after mercury exposure. Symptomatic treatment and corticosteroid administration assured rapid clinical improvement. Chronic mercury poisoning can masquerade as an autoimmune or systemic inflammatory disease.
Conclusion: Physicians should be aware that low exposure to mercury, even from artisanal gold mining, may be harmful to health. Management can be simple without the need for aggressive or invasive therapeutic measures. Larger case series are required in order to establish a clear management plan.
Syversen T, Kaur P. The toxicology of mercury and its compounds. J Trace Elem Med Biol 2012;26:215–226.
Bensefa-Colas L, Andujar P, Descatha A. Intoxication par le mercure. Rev Méd Interne 2011;32:416–424.
Risher JF. Elemental mercury and inorganic mercury compounds: human health aspects. Geneva: World Health Organization; 2003.
Caravati EM, Erdman AR, Christianson G, Nelson LS, Woolf AD, Booze LL, et al. Elemental mercury exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 2008;46:1–21.
Tchounwou PB, Yedjou CG, Patlolla AK, Sutton DJ. Heavy metal toxicity and the environment. EXS 2012;101:133–164.
Graeme KA, Pollack CV. Heavy metal toxicity, Part I: arsenic and mercury. J Emerg Med 1998;16:45–56.
Dantzig PI. A new cutaneous sign of mercury poisoning? J Am Acad Dermatol 2003;49:1109–1111.
Lucchini R, Cortesi I, Facco P, Benedetti L, Camerino D, Carta P, et al. Neurotoxic effect of exposure to low doses of mercury. Med Lav 2002;93:202–214.
Bernhoft RA. Mercury toxicity and treatment: a review of the literature. J Environ Public Health 2012;2012:460508.
Doering S, Bose-O’Reilly S, Berger U. Essential indicators identifying chronic inorganic mercury intoxication: pooled analysis across multiple cross-sectional studies. PLoS One 2016;11:e0160323.
Boyd AS, Seger D, Vannucci S, Langley M, Abraham JL, King LE. Mercury exposure and cutaneous disease. J Am Acad Dermatol 2000;43(1 Pt 1):81–90.
Heise LA, Wagener BM, Vigil JR, Othman M, Shahinpoor P. Hemorrhagic colitis secondary to acute elemental mercury vapor poisoning. Am J Gastroenterol 2009;104:530–531.
Elli L, Bardella MT, Pigatto PD, Guzzi G. Mercury vapor overexposure and hemorrhagic colitis. Am J Gastroenterol 2009;104:2124.
Crowe W, Allsopp PJ, Watson GE, Magee PJ, Strain JJ, Armstrong DJ, et al. Mercury as an environmental stimulus in the development of autoimmunity - a systematic review. Autoimmun Rev 2017;16:72–80.
Mok CC, Leung B, Fong B, Wong CK. THU0300 serum mercury level and disease activity of systemic lupus erythematosus (SLE): a case-control study. Ann Rheum Dis 2013;72(Suppl 3):A267–A267.
Attar AM, Kharkhaneh A, Etemadifar M, Keyhanian K, Davoudi V, Saadatnia M. Serum mercury level and multiple sclerosis. Biol Trace Elem Res 2012;146:150–153.
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