SHM Converge Scientific Abstract ePoster Gallery-A Tale of Two Brothers: Acute and Chronic Mercury Toxicity

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Two brothers, ages 12 and 16, were evaluated for worsening symptoms after known mercury exposure. Over six months, both developed nonspecific but progressive complaints including musculoskeletal pain, paresthesias, urinary urgency, diarrhea, body aches, night sweats, weakness, weight loss, rash, somnolence, personality changes, and declining school performance. Extensive infectious, rheumatologic, and oncologic workups were unrevealing until urine testing showed elevated mercury levels. The older brother later reported receiving a vial of unknown metallic liquid that repeatedly leaked and may have aerosolized in their bedroom.<br /><br />On exam, the younger brother had hypothermia, decreased attentiveness, generalized hyporeflexia, leg tenderness, a truncal maculopapular rash, and desquamating palmar rash. The older brother mainly had skin findings. Because of concern for delayed deterioration, both were admitted for monitoring and chelation. The younger brother initially required ICU care for temperature support and a sepsis evaluation. Both were treated with N-acetylcysteine and selenium based on Poison Control guidance and received neuropsychiatric follow-up before discharge.<br /><br />The report emphasizes that mercury toxicity can present acutely with dysgeusia, dyspnea, vomiting, and diarrhea, or chronically with neurologic dysfunction, weakness, fatigue, anorexia, and GI symptoms. Cutaneous findings may also occur. Neurologic manifestations include tremor and erethism, which involves personality and behavior changes, memory loss, insomnia, depression, hallucinations, and fatigue. Evaluation of suspected cases should also rule out infectious, autoimmune, and endocrine causes.<br /><br />Treatment depends on severity and chronicity. Succimer is standard chelation for acute heavy metal poisoning, but it does not cross the blood-brain barrier well, so alternatives such as N-acetylcysteine and selenium may be beneficial in chronic neurologic toxicity. The case highlights the need to consider toxic exposure in patients with unexplained systemic symptoms, especially when multiple household members are affected, and to coordinate care with Poison Control and public health authorities.

Asset Subtitle

Sejal Mehta

Meta Tag

Author List Christopher K. Wong, Sejal Mehta

Category Clinical Vignettes

Concept Mercury Toxicity

Concept Erethism

Concept Tremor

Concept Differential Diagnosis

Concept Poison Control

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Sejal Mehta

Track Pediatric

Keywords

mercury toxicity

heavy metal poisoning

chelation therapy

neurologic symptoms

mercury exposure

paresthesias

personality changes

cutaneous rash

Poison Control

selenium treatment

Mercury Toxicity

Erethism

Tremor

Differential Diagnosis

Poison Control