An Enigmatic Case of Acute Mercury Poisoning: Clinical, Immunological Findings and Platelet Function

Abstract

Severe mercury intoxication is very rare in developed countries, but still occurs as the result of volatile substance abuse, suicide attempts, occupational hazards, or endemic food ingestion as reported in the cases of public health disasters in Iraq and in Minamata Bay, Japan. Here, we describe the dramatic physical and cognitive decline of a 23-year-old patient caused by a severe methyl mercury (MeHg) intoxication of unknown origin. We show serial magnetic resonance imaging (MRI) of the patient’s brain, as well as ex vivo analyses of blood and cerebrospinal fluid including multicolor flow cytometric measurements, functional assays of hemostaseologic efficacy, and evaluation of regulatory effector molecules. Together with the clinical history, our findings show the progressive neuronal degeneration accompanying the deterioration of the patient. Moreover, the ex vivo analyses display alterations of thrombocyte function and coagulation, as well as an immunological milieu facilitating autoimmunity. Despite the successful reduction of the MeHg concentration in the patient’s blood with erythrocyte apheresis and chelator therapy, his condition did not improve and led to a persistent vegetative state. This case illustrates the neurotoxicity of MeHg following severe intoxication for the first time by serial MRI. Data on immune-cell and thrombocyte function as well as on coagulation in mercury poisoning reveal potential implications for anticoagulation and immunomodulatory treatment.

Investigation and monitoring of heavy metal poisoning

“…Individuals may ingest or inject elemental mercury or mercury salts as an act of self-harm or in the mistaken belief that they will derive benefit 42–45. Measurement of blood and urine mercury concentrations provides valuable information about systemic uptake.…”

Risk Analysis of Specific Environmental Heavy Metals as a Trigger of CD4 & CD8 Among Cases of Multiple Sclerosis:Case - control study.

“…As regards mercury, it was demonstrated that; acute Methyl mercury poisoning leads to a stimulation of the immune system, especially of cytotoxic CD8+ T cells, whereas CD4+ T cell number and activation remain unaltered. Of note, certain functionally and phenotypically distinct subpopulations of thymicderived CD4+ T regulatory cells can control and limit potentially harmful immune responses Kleffner 16 .…”

Another umbrella murder? – A rare case of Minamata disease

“…Nowadays, suicides as well as homicides with mercury compounds are rare [12][13][14][15]. Nevertheless, there are several reports of homicidal, suicidal and accidental mercury intoxications in the last centuries.…”

“…A well-known example for an accidental mercury intoxication is the case of Karen Wetterhahn (American professor of chemistry) who died from a Dimethylmercury intoxication caused by wearing insufficiently protective gloves [17]. Except for criminal cases and suicides in which metallic mercury compounds were used, there is a particular case report about criminal mercury poisoning using heated tobacco products [13] and one report about a homicidal methylmercury intoxication [15].…”