Stevens-Johnson syndrome in a child with chronic mercury exposure and 2,3-dimercaptopropane-1-sulfonate (DMPS) therapy

Abstract

Introduction. Stevens-Johnson syndrome (SJS) is an uncommon and potentially serious mucocutaneous disease. The most important step in the management of SJS is early recognition and immediate withdrawal of the causative agent. We present a patient with SJS associated with dimercaptopropane-1-sulfonate (DMPS) therapy. Case Report. An asymptomatic 11-year old boy who had been exposed chronically to mercury vapour had a 24-hour urine mercury concentration of 37 microgram/L (reference value <10 microgram/L). Exposure to the mercury vapour was stopped and treatment with oral DMPS was begun. After two weeks of therapy, he developed a disseminated cutaneous eruption of red pruritic macules on his chest and back, which three days later had spread all over his body with the discrete maculae becoming confluent; erosions and crusts developed on his lips and he had blisters in his mouth. The diagnosis of SJS was made, the DMPS was stopped, and the SJS resolved gradually. Discussion. Chelation agents like DMPS or DMSA are increasingly used and are available over the counter in some countries. These drugs are used in patients with complaints that are attributed to mercury-containing dental amalgams and in children with autism. Conclusion. The reported association suggests that SJS may be a potential complication of DMPS therapy, and this should be considered in the risk-benefit analysis of chelation. The reported association suggests that SJS may be a potential complication of DMPS therapy, and this should be considered in the risk-benefit analysis of chelation.

Characteristics and treatment of elemental mercury intoxication: A case series

“…40 DMPS is generally well tolerated; it can cause a dosedependent increase in urinary copper excretion, and Stevens-Johnson syndrome has been reported to occur after administration of DMPS. 41,42 The patients described in this case series all had a favorable clinical outcome once the diagnosis of elemental mercury intoxication was established, suggesting that the significant clinical effects that may occur as a consequence of this intoxication are reversible with treatment including source identification and remediation as well as chelation therapy. A significant limitation of this analysis is the low number of patients included in this case series.…”

“…Compared with DMSA, DMPS remains in the body for longer, acts more quickly, and is more effective in chelating patients with inorganic mercury intoxication 40 . DMPS is generally well tolerated; it can cause a dose‐dependent increase in urinary copper excretion, and Stevens‐Johnson syndrome has been reported to occur after administration of DMPS 41,42 …”

Current Use of Chelation in American Health Care

“…The Federal Register states that "DMPS appears to be relatively nontoxic, and serious adverse affects associated with its use has not been commonly reported" [13]. This conclusion may understate the potential problems with DMPS, as DMPS has been associated with Stevens-Johnson syndrome [14].…”

Chelatbildner mit Thiolaktivität

“…Beim SJS lösen sich definitionsgemäß maximal 10% der Haut, beim TEN mehr als 30%, zwischen 10 und 30% spricht man von Übergangsformen [1]. Trotz des theoretischen Sensibilisierungspotenzials von Dithiolen gibt es bisher nur einen Fallbericht über ein SJS unter DMPS-Therapie -leider ohne Histologie oder allergologische Diagnostik [8]. Über das Auslösen einer bullösen Autoimmundermatose durch DMPS, wie es für den Chelator DPenicillamin, der ebenfalls über eine Thiolgruppe verfügt, beschrieben wurde [2], liegen bisher keine Berichte vor.…”