A 48-year-old male called the poison control center noting his "skin is starting to peel off". He stated ten days prior, a container fell from a shelf and spilled approximately 100 milliliters of elemental mercury used for gold extraction. Because it was felt there was a still valuable amount of gold in the mercury, he explored the silvery material for any recoverable specs of gold. Once complete, he used a vacuum to remove the mercury, and swept the remainder under a rug. He noted it was a cold January day, and turned the heat on, also noting there was no exhaust ventilation in this room. He felt he might be coming down with influenza-like-illness (ILI), and spent the next week in bed (in this same room).The patient was referred to the local emergency department (ED), and instructed to notify the county hazardous materials agency of the spill. In the ED, his vital signs were within normal limits. He was noted to have a desquamating rash of his upper and lower extremities, with mild erythema (Figures 1 and 2). He complained of numbness of his fingers and lower extremities. Laboratory tests including a complete metabolic panel and complete blood count were within normal limits. An electrocardiogram and chest x-ray was normal. A whole blood mercury test and spot urine mercury test were obtained and returned (one week later) with values of 262 mcg/L (reference range; <10 mcg/L) and 144 mcg/g creatinine (reference range; non-exposed adult <4 mcg/g creatinine) respectively. The patient was referred to the Occupational and Environmental Clinic, where he was seen four weeks after the initial event. His county public health agency was notified of the event. He denied any tremor, but noted recent personality changes including depression and decreased interest in social interaction. He noted his rash had resolved, but he continued to have a sensory neuropathy, complaining of worsening balance, dizziness, cold sensitivity and numbness of his arms and legs. These neurologic symptoms limited his occupational and recreational activities, including woodworking, playing a musical instrument and dancing. He noted he had relocated from the location of the mercury spill. A repeat whole blood mercury level returned at 13 mcg/L and a twenty-four hour urine collection returned at 44 mcg/L (reference range; <20 mcg/L). Formal neurologic testing was offered, but due to the patient's lack of health insurance, he was unable to complete this testing. He was lost to follow-up following his clinic visit. The county department of public health was informed about a potential mercury spill at the residence but they were unable to make contact with the patient and the residence was not evaluated.