SYSTEMIC ILLNESS FROM SUBCUTANEOUS ELEMENTAL MERCURY INJECTION

Background: Many cases of subcutaneous (sc) elemental mercury ([Hg.sup.0]) injection resulting in skin granulomata are reported, but there is little associated systemic illness. We report a case of debilitating illness in a patient with repeated sc [Hg.sup.0] injections. Case Report: A 31-year-old Belizian woman complained of lumps on her fingers. Other symptoms included weight loss, nausea, weakness, and oral pain. She reported multiple injections of [Hg.sup.0] sc in the mouth and small joints of the hands and feet over 3 years, done for medicinal purposes. On exam, she had cachexia, granulomatous nodules on her face, digits and extremities, severe stomatitis in areas of oral injection, and a normal neurologic exam. Radiographs and CTs revealed Hg deposits in the soft tissues of the hands, face, palate, tonsils, ears, eyelids, and occiput. Punctate deposits of Hg occurred in the liver, spleen and lung periphery. The patient had a hypoproliferative anemia, low CD4 count, and impaired gas exchange (DLCO 52% predicted). Work-up for autoimmune and HIV disease was negative. Biopsy of a nasal bridge lesion showed suppurative and granulomatous inflammation surrounding dense droplets. One month after her last injection, blood Hg was 3.38 [micro]g/gm blood, and urine Hg 11,000 [micro]g/L. The blood Hg declined over several months, but eventually returned to a similar level. Five months after last injection, she developed proteinuria. The skin lesions responded to topical steroids, but new lesions continue to appear. Months after the treatment of the stomatitis, she remains cachectic. The safety of chelation in this patient is questioned, and she has not been chelated. Conclusion: [Hg.sup.0] injection has resulted in a wasting illness, with recurring skin granulomata, anemia, impaired cell mediated immunity, impaired gas exchange, and renal pathology, but no evident CNS disease. The patient's blood Hg levels are among the highest reported.
Krantz A, Couture E, Barke L, Vawter A, Hryhorczuk D. Cook County Hospital, Chicago, [...]