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Koh C, Kwong KL, Wong SN. Mercury poisoning: a rare but treatable cause of failure to thrive and developmental regression in an infant. Hong Kong Med J 2009; 15:61-64. [PMID: 19197099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
An infant presented with failure to thrive and developmental regression. Physical examination revealed an irritable child with swollen, erythematous extremities, and elevated blood pressure. Extensive investigations, including a metabolic work-up and neuroimaging, were unrevealing. Exposure to self-purchased medication was initially denied. The physical signs were suggestive of acrodynia. Mercury poisoning was ultimately established by measuring paired blood and urine mercury levels. On further enquiry, it was revealed that the child had been given a Chinese medicinal product for 4 months. He responded well to a chelating agent. Acrodynia is a childhood disease considered to be of historical interest only, but making a diagnosis of mercury poisoning is rewarding because the response to treatment is good. This case highlights the common misconception that alternative medicines are safe and benign.
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Affiliation(s)
- Caroline Koh
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
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Abstract
Mercury vapor poisoning is a serious and potentially fatal problem. Neurological manifestations involving the central nervous system are seen with chronic mercury intoxication. We present the case of a 10-year-old child who demonstrated acrodynia, seizures, and visual impairment following 20 days of exposure to elemental mercury at home. The initial blood mercury concentration was 27.7 microg/L (normal <2 microg/L) and the initial 24-hour urine mercury concentration was 34.4 microg/L (normal =10 microg/L). After 9 months of treatment with D-penicillamine, the patient's clinical condition, biochemical laboratory parameters, and mercury concentrations all returned to normal. The T2-weighted MRI images of the patient's brain initially showed multiple hyperintense lesions in cerebral white matter, left globus pallidus, and putamen, which also improved.
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Affiliation(s)
- Parvin Abbaslou
- Pediatrics Department, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Michaeli-Yossef Y, Berkovitch M, Goldman M. Mercury intoxication in a 2-year-old girl: a diagnostic challenge for the physician. Pediatr Nephrol 2007; 22:903-6. [PMID: 17310361 DOI: 10.1007/s00467-007-0430-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2006] [Revised: 12/15/2006] [Accepted: 12/19/2006] [Indexed: 10/23/2022]
Abstract
A 2-year-old girl presented with hypertension, anorexia and vomiting, restlessness, insomnia and acrodynia. Her blood pressure upon arrival was 145/98 mmHg. Ultrasound of the abdomen, CT scan of chest, abdomen and pelvis, and echocardiogram, were normal. Urinary levels of catecholamines were elevated, urine level of mercury was found to be high (33.2 microg/g creatinine), although blood level was normal (>0.5 microg/dl, reference value 0-4 microg/dl). Following a 1-month course of oral treatment with dimercaptosuccinic acid (DMSA) the child's symptoms and signs resolved, and urinary mercury and catecholamines levels normalized. Mercury intoxication should be suspected in a patient with severe hypertension, personality changes and acrodynia. Normal blood levels of mercury do not exclude this diagnosis, and catecholamine levels may serve as a surrogate marker for confirmation of the diagnosis and to evaluate response to treatment.
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Abstract
A3-year-old boy presented to the Hospital for Sick Children with systemic symptoms and oropharyngeal and peripheral extremity changes suggestive of Kawasaki disease. He was found to have severe hypertension. Investigation for a catecholamine-secreting tumor was negative. Toxins were considered when the patient's 20-month-old brother presented with similar symptoms, and the boys were subsequently diagnosed with elemental mercury poisoning. We review the literature on mercury intoxication and discuss the historical context, clinical syndrome (acrodynia), treatment, and radiologic findings of this unusual diagnosis.
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Affiliation(s)
- Carolyn Beck
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
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Chrysochoou C, Rutishauser C, Rauber-Lüthy C, Neuhaus T, Boltshauser E, Superti-Furga A. An 11-month-old boy with psychomotor regression and auto-aggressive behaviour. Eur J Pediatr 2003; 162:559-561. [PMID: 12751003 DOI: 10.1007/s00431-003-1239-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2003] [Accepted: 04/02/2003] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | - Thomas Neuhaus
- Department of Paediatrics, University Children's Hospital, Zürich, Switzerland
| | - Eugen Boltshauser
- Department of Paediatrics, University Children's Hospital, Zürich, Switzerland
| | - Andrea Superti-Furga
- Department of Paediatrics, University Children's Hospital, Zürich, Switzerland.
- Division of Molecular Paediatrics, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Weinstein M, Bernstein S. Pink ladies: mercury poisoning in twin girls. CMAJ 2003; 168:201. [PMID: 12538551 PMCID: PMC140434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
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Kazantzis G. Mercury exposure and early effects: an overview. Med Lav 2002; 93:139-47. [PMID: 12197264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVES This paper was given as a keynote address at the conference on The Assessment of the Effects Due to Low Doses of Inorganic Mercury following Environmental and Occupational Exposures: Human and in vitro Studies on the Specific Mechanisms of Toxicity in Gargnano, Italy, in September 2001. METHODS The most relevant literature over the past 40 years has been reviewed, and in particular, the proceedings of the World Health Organisation conferences on the health effects of inorganic and organic mercury exposure have been considered. RESULTS In an uncontaminated environment the general population is exposed to mercury vapour from the atmosphere and from dental amalgam, while the diet, mainly from fish, is the principal source for methyl mercury absorption. Mercury vapour release from amalgam fillings increases with chewing, with absorption and uptake by the brain and kidneys. Infants exposed to phenyl mercury from treated diapers and young children ingesting mercurous chloride in teething powders have developed acrodynia (pink disease), and Kawasaki disease and the use of mercurial skin lightening creams has been followed by the development of the nephrotic syndrome. Both mercury compounds and mercury vapour have given rise to contact dermatitis in the general population. Epidemics of mercury poisoning have followed release of mercury into the environment from industrial activity, with uptake of methyl mercury from fish eating in Minamata Bay and uptake of both inorganic and methyl mercury following release of mercury vapour and deposition into waterways from gold recovery procedures in the Amazon basin. The ingestion of wheat and barley seed treated with an alkyl mercury fungicide for sowing, by a largely illiterate population in Iraq, led to a major outbreak of poisoning with a high fatality rate. Following exposure to mercury vapour, the earliest clinically observed adverse effects at urine mercury levels of the order of 30-100 mg/g creatinine, are objectively detectable tremor, psychological disorder and impaired nerve conduction velocity in sensitive subjects, with subjective symptoms of irritability, fatigue and anorexia. At these and at lower levels, proteinuria has also been observed. Both glomerular and tubular damage may occur at exposure levels lower than those giving rise to central nervous system effects. An immunological effect has also been observed in studies on clinically asymptomatic workers with low level exposure. CONCLUSIONS As mercury can give rise to allergic and immunotoxic reactions which may be genetically regulated, in the absence of adequate dose-response studies for immunologically sensitive individuals, it has not been possible to set a level for mercury in blood or urine below which mercury related symptoms will not occur.
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Affiliation(s)
- G Kazantzis
- Environmental Geochemistry Research Group, Department of Environmental Science and Technology, Imperial College of Science, Technology & Medicine, Prince Consort Road, London SW7 2BP, UK
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Abstract
Human contact with mercury has been ongoing for centuries and was previously considered a legitimate means of treating different cutaneous and systemic conditions. Toxicity from this heavy metal may occur from exposure to elemental, inorganic, and organic forms of mercury. This article outlines the signs and symptoms of mercury poisoning and the different clinical conditions with assorted cutaneous findings.
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Affiliation(s)
- A S Boyd
- Department of Medicine (Dermatology), Vanderbilt University, Nashville, TN, USA
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Elemental mercury poisoning in a household--Ohio, 1989. MMWR Morb Mortal Wkly Rep 1990; 39:424-5. [PMID: 2113168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Mercury exposure from interior latex paint--Michigan. MMWR Morb Mortal Wkly Rep 1990; 39:125-6. [PMID: 2106060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Stone OJ. Pyridoxine deficiency and antagonism produce increased ground substance viscosity with resulting seborrheic dermatitis and increased tumor resistance. Med Hypotheses 1989; 30:277-80. [PMID: 2533316 DOI: 10.1016/0306-9877(89)90037-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pyridoxine deficiency and 4'-deoxypyridoxine produce acrodynia in rats and seborrheic dermatitis in man. They also produce tumor inhibition in man and animals. Pyridoxine is extensively involved in metabolism and its relationship to the inhibitor 4'-deoxypyridoxine is complex. Pyridoxine deficiency and antagonism increases ground substance viscosity. This increase the inflammatory reactivity of the skin to produce acrodynia in rats and seborrheic dermatitis in man. The increase in ground substance viscosity would explain the increased resistance to tumors in man and animals. Pyridoxine is important in protein metabolism. The protein moiety of glycosaminoglycans in ground substance is small but plays a major role in tissue viscosity. Pyridoxine deficiency or antagonism by itself does not offer a definitive answer for tumors. Combined with substances that stimulate fibroblast or glycosaminoglycans production it may have a significant additive effect.
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de Fockert JA. [Geriatric visit 7. Imminent immobility in old age]. Tijdschr Ziekenverpl 1984; 37:22-5. [PMID: 6560932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Magrizos C, Remogna M, Leo D, Pilotti G. [Notes on a case of acrodynia. Mercury poisoning, hyperreninemia hyperaldosteronemia]. Minerva Pediatr 1982; 34:925-8. [PMID: 6759912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Meme JS, Brown JD, Kagia J, Dawa BA, Kihia W. Mercury poisoning as a cause of acrodynia in Kenya children--a preliminary report. East Afr Med J 1981; 58:641-9. [PMID: 7318717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Bai KI, Sastry VN, Rao MD, Rao GK. Acrodynia--(a case report). Indian Pediatr 1979; 16:81-2. [PMID: 437888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Alexander JF, Rosario R. A case of mercury poisoning: acrodynia in a child of 8. Can Med Assoc J 1971; 104:929-30. [PMID: 5574062 PMCID: PMC1930744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Schöne D, Wässer S, Polster H. [Clinical aspects of acrodynia (von Feer's syndrome)]. Kinderarztl Prax 1970; 38:390-6. [PMID: 5508069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Anastasatu C, Kauffmann S, Iancovici O. [Manifestations of a rheumatic type caused by antituberculosis chemotherapy]. Med Interna (Bucur) 1969; 21:557-60. [PMID: 5307329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Verma IC, Singh S. Acrodynia. Report of a case. Indian J Pediatr 1968; 35:441-3. [PMID: 5720049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Knolle G. [Allergic reactions due to dental drugs and materials]. Dtsch Stomatol 1966; 16:547-58. [PMID: 5222010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Tajtáková C. [Acrodynia]. BRATISL MED J 1966; 46:767-70. [PMID: 5945548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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de Haas WH. [Acrodynia caused by intravaginal tablets containing acetarsol]. Ned Tijdschr Geneeskd 1966; 110:432-4. [PMID: 5906972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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SMEBY B. [Acrodynia]. Nord Med 1959; 62:1233-4. [PMID: 13831785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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FABIAN P. [Pathogenesis of acrodynia]. Cesk Pediatr 1958; 13:124-7. [PMID: 13537101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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GAUTIER J. [Morvan's fibrillary chorea & acrodynia]. Sem Med Prof Med Soc 1958; 34:83-6. [PMID: 13529110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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PINK DISEASE. Br Med J 1957; 2:402-3. [PMID: 13446500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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KALSBEEK F, BLOMHERT G. [Subacute mercury poisoning resembling acrodynia caused by an oral mercurial diuretic]. Ned Tijdschr Geneeskd 1957; 101:233-5. [PMID: 13418851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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FLUCKIGER P. [A new argument for neuro-allergic genesis of acrodynia (Feer's disease)]. Helv Paediatr Acta 1956; 11:342-5. [PMID: 13405330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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STELGENS. [Etiology and pathogenesis of Feer's disease]. Monatsschr Kinderheilkd (1902) 1956; 104:117-8. [PMID: 13321820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
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VIANOVA X, PINOL J. [Acrodynia and mercury; clinical case report]. Bull Soc Fr Dermatol Syphiligr 1955:528-9. [PMID: 13316378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
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GUGLIELMO B. [Case of acrodynia in a 9-month old infant; etiopathogenesis]. Minerva Nipiol 1955; 5:153-60. [PMID: 13334139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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JOCHIMS J. [Avoidable mercurial accidents of young children; acrodynia, Hg dermatitis]. Med Klin 1954; 49:1412-3. [PMID: 13203036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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GAMALERO PC. [Two cases of acrodynia following chloramphenicol therapy]. Minerva Pediatr 1954; 6:432. [PMID: 13193855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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ANNOTATIONS. Br Med J 1954; 1. [PMID: 13115690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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