An unusual case of mercurial baboon syndrome from metallic mercury in a broken industrial barometer

Current understanding of Baboon syndrome

“…Systemic exposure to contact allergens, such as mercury, and systemic use of drugs without previous cutaneous application (e.g., amoxicillin) were the main causes. There is a widespread geographical distribution of mercury-induced BS, with a preponderance in countries where topical mercurial antiseptics (e.g., merbromin) are frequently used, such as in Japan, Korea, Spain, Portugal, Belgium, France, Australia and Turkey [2, [11][12][13][14][15]. Females and males of any age seem to be equally affected by mercury-induced BS [16], whereas there is a predominance of middle-aged male patients (70%) observed in drug-induced BS [17].…”

“…Blood chemistry and hematology are normal. Mild eosinophilia [19,30] or leukocytosis with positive C-reactive protein [2], fever, headache, nausea, vomiting, abdominal pain and diarrhea, malaise, arthralgia and hypotension have been reported rarely [2,5,11,34,41,42]. In some cases of mercury-induced BS, elevated nontoxic levels of mercury can be detected in blood and urine, indicating exposure and absorption [10,11,16,30].…”

“…Merbromin in topical antiseptics, such as mercurochrome, that is applied even to the umbilical cord of the newborn, thimerosal in previous vaccinations or ophthalmologic preparations or dental amalgam, are usually regarded as primary sensitizers [2,11,12,16,19,47]. In previously sensitized patients with mercury compounds, BS is most commonly provoked by the inhalation of metallic mercury vapors from a broken thermometer due to the unique feature of mercury as a metal existing in liquid form and capable of evaporating at room temperature [1,2,11,19].…”

“…In previously sensitized patients with mercury compounds, BS is most commonly provoked by the inhalation of metallic mercury vapors from a broken thermometer due to the unique feature of mercury as a metal existing in liquid form and capable of evaporating at room temperature [1,2,11,19]. Other less frequent sources of systemic mercury exposure include vaccines, toxoids, γ-globulin preparations, contact lens solutions and anti-toxins [61], or even accidental ingestion [62] or permucosal absorption [63,64] of topically applied mercurial compounds.…”

“…The published cases up to 2002 are summarized in a recent report [16]. The eliciting mercury source was a broken thermometer in the majority of cases [1,2,13,20,28,47,[81][82][83], followed by a broken industrial barometer [11], sphygmomanometer [84], metallic mercury vapor at school [85], cinnabar mines [86], plastic boots [87], mercury-containing tablets in a homeopathic medicine [12] or lozenge [16], mercury-containing antiparasitic powder to treat phthiriasis [34], old leaking batteries in a Geiger counter [16] and dental amalgam fillings, particularly during insertion and removal [2], in single cases. Unusual sources of mercury exposure have also been documented, such as mercury that was kept in a bottle as a toy [37], as a table decoration [14], for good luck [15], from the cracked cover of a skill game called 'mercury maze' [42] or even because of purposely breaking thermometers for playing or experimenting with mercury droplets [88], and recently from accidental ingestion of mercurial skin-lightening cream that was topically applied to the upper lip [62].…”