Mercury toxicity presenting as acrodynia and a papulovesicular eruption in a 5-year-old girl

Abstract

Acrodynia is a reaction that occurs in children who have been exposed to mercury. Mercury toxicity has systemic manifestations as well as cutaneous manifestations, which can appear similar to those found in a number of other diseases. We present a case of acrodynia caused by mercury exposure in a previously healthy 5-year-old girl who developed hypertension, palmoplantar pruritus, and a papulovesicular eruption. Case synopsisA 5-year-old previously healthy girl was admitted to the hospital for two months of increasing migratory joint pain, new-onset recalcitrant hypertension, irritability, photophobia, decreased appetite, and one week of intensely pruritic palmoplantar papules and vesicles. During hospitalization, her blood pressure increased to a maximum of 159/113 mm/Hg and remained on average 145/105 mm/Hg, necessitating triple anti-hypertensive therapy with amlodipine, labetalol, and hydralazine. Figure 1. Monomorphic erythematous papules and vesicles on the back (a) and hand (b). Exfoliation is beginning to occur on the distal fingers (b) and toes (c).

Characteristics, Treatment, and Prognosis of Elemental Mercury Intoxication in Children

“…In the intermediate phase, multisystem findings such as severe pulmonary (pneumonia, pneumomediastinum, and pneumothorax), renal (proteinuria, glomerulonephritis, tubulopathy), dermatological (acrodynia with painful, pinkish discoloration, swelling of extremities, desquamation, erythema, wet extremities), hepatic, hematological (leukemia), cardiovascular (tachycardia, hypertension), nervous (headache, tremor, delusions, hallucinations, sensorimotor polyneuropathy, memory loss, ataxia, coordination disturbances, dysdiadochokinesia), psychosomatic (mercurial erethism, shyness, loss of memory, excitability, insomnia), and rheumatologic (malaise, weight loss, thrombocytosis, hypertension, myalgia, rash, elevation of acute-phase reactants, and thyroid hormones) dysfunctions may be possible. At the end stage, lung damage is the leading cause of death 2,3,7,8,19,21–31 . Most of our patients were exposed to mercury through their breathing, but there were no signs or symptoms of lung damage.…”

“…At the end stage, lung damage is the leading cause of death. 2,3,7,8,19,[21][22][23][24][25][26][27][28][29][30][31] Most of our patients were exposed to mercury through their breathing, but there were no signs or symptoms of lung damage. Malaise (14.3%), muscle pain (14.3%), Amenorrhea, photophobia, and headache plagued the 17-year-old sister as well.…”

Nephrotic Syndrome Associated With Heavy Metals Exposure: A Case Report and Literature Review

“…Several studies showed that low concentrations of mercury induced activation of both cellular and humoral immunity in rats [12][13][14]. Diagnosis of elemental mercury toxicity should be suspected among individuals who present with consistent clinical manifestations and who have a history of exposure risk via occupation or have days to weeks of exposure to elemental mercury via a broken mercury-containing device or other mercury spill [15][16][17][18]. Diagnosis is confirmed by measuring whole blood mercury levels and 24-hour urine levels.…”

Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table

“… Dermatological manifestations of acrodynia: maculopapular rash in the trunk ( A , B ), exfoliation on fingers and pink discoloration of nails ( C ) and toes ( D ), hyperpigmentation with multiple cysts, chloracne-like lesions of face and neck ( E ), swan-neck deformity of both fingers ( F ), bluish gray-stained area on the skin ( G ). Reprinted from ( A )—[ 215 ], ( B – D )—[ 268 ], ( E , F )—[ 269 ], ( G )—[ 270 ]. …”