Case report: metallic mercury embolism--deliberate self-injection

Toxicokinetics and toxicodynamics of elemental mercury following self-administration

INTRODUCTION

Intravenous injection of mercury has seldom been reported, especially in cases of attempted suicide, and is associated with variable clinical outcomes.

CASE REPORT

A young woman came to our attention after self-injecting and ingesting mercury drawn from 37 thermometers. The patient suffered lung embolization complicated by adult respiratory distress syndrome (ARDS), toxic dermatitis, anemia, mild hepato-renal impairment, and died after 30 days. Mercury was monitored in biological fluids (blood, plasma, urine, and bronchoalveolar fluid) to study its toxicokinetics and to evaluate dose-effect relationships. Its urinary clearance significantly increased after a chelation challenge test with meso-2,3-dimercaptosuccinic acid (DMSA) (median values of 2.48 and 8.85 before and after the test, respectively, p < 0.05).

CONCLUSIONS

Mercury poisoning by intravenous injection is a clinical emergency, potentially leading to death. When injected, the element has a very slow clearance, mainly renal. Our data do not allow any conclusion about the effectiveness of chelation therapy.

Membranous fat necrosis due to subcutaneous elemental mercury injections

Membranous fat necrosis (MFN) is a distinct abnormality in systemic and subcutaneous fatty tissue. Although ischemia and trauma have been implicated in its causation, the exact pathogenesis of MFN remains unknown. The deposition of metallic mercury in subcutaneous tissue due to accidental penetration or deliberate injection of mercury is unusual. Depending on the duration of the deposition, localized necrosis, suppuration, and granuloma formation have been described at mercury injection sites. We report subcutaneous MFN, a hitherto unrecognized histopathologic phenomenon at sites of mercury deposition, in a 21-year-old soccer player who had deliberate subcutaneous and intramuscular elemental mercury injections to improve his sporting performance.

Thoracic foreign bodies in adults

AIM

The aim of this pictorial essay is to illustrate a range of imaging manifestations of thoracic foreign bodies.

METHODS AND RESULTS

The essay includes documented intrathoracic foreign bodies introduced by inhalation, aspiration, penetrating trauma or ingestion. Imaging modalities include chest radiography and computed tomography (CT).

CONCLUSIONS

The majority of foreign bodies are seen on the plain chest radiograph. CT is helpful in demonstrating the presence of radiolucent foreign bodies and determining the exact location of the foreign bodies within the airways or lung parenchyma.

Lessons to be learned: a case study approach. An unusual case of alveolar deposition from swallowing metallic mercury in an attempt at self-poisoning

The authors report a case of deliberate self-poisoning in a drug addict who swallowed elemental mercury: in so doing he inadvertently acquired a permanent diffuse deposition of mercury particles throughout both lung fields. Swallowed mercury should be relatively harmless in small quantity but the high specific gravity and free flowing properties of elemental mercury allowed it to overcome the normal swallowing pathways--such that some of it passed into the bronchial tree instead of passing harmlessly through the gut. In that site its significant vapour pressure, together with its potential for oxidation to inorganic mercury--which may, in turn, be absorbed across the alveolar membrane, gives high potential for mercury poisoning.