title: Elemental mercury-induced skin granuloma: a case report and review of the literature.
abstract: BACKGROUND
  Injection of elemental mercury is rare and only some 72 cases have been reported in the literature over the period 1923-1995. Direct subcutaneous injection or extravasation of mercury injected into blood vessels can produce local granulomata and abscesses. Unless intravascular mercury injection has occurred, clinical signs of mercury toxicity are usually absent though four cases of systemic toxicity have been reported following isolated subcutaneous injection without evidence of elemental mercury dissemination.
  
  
  METHODS
  We report a further case of subcutaneous injection by gunshot of elemental mercury, with subsequent granuloma formation, in a 19-year old man who was admitted with an eight month history of a tender enlarging mass in his left antecubital fossa, while on active military service. Surgical removal of mercury from a presumed mercury-tipped bullet was undertaken but was incomplete and the patient declined further operative intervention as he remained asymptomatic. Chelation therapy was not instituted. Serum and urine mercury concentrations were measured for six years after presentation.
  
  
  CONCLUSIONS
  We recommend that cases of subcutaneous metallic mercury injection should be managed by complete surgical excision of the granuloma under X ray control and serial monitoring of blood and urine mercury concentrations.
authors.affiliation: City Hospital NHS Trust, Birmingham, United Kingdom.
authors.forename: S M
authors.initials: SM
authors.lastname: Bradberry
authors.forename: M A
authors.initials: MA
authors.lastname: Feldman
authors.forename: R A
authors.initials: RA
authors.lastname: Braithwaite
authors.forename: W
authors.initials: W
authors.lastname: Shortland-Webb
authors.forename: J A
authors.initials: JA
authors.lastname: Vale
mesh_terms: D000328:Adult; D004550:Elbow; D015745:Granuloma, Foreign-Body / Q000209:etiology*; D006801:Humans; D007267:Injections; D008297:Male; D008628:Mercury / Q000009:adverse effects* / Q000097:blood / Q000652:urine; D012871:Skin Diseases / Q000209:etiology*; D014948:Wounds, Gunshot / Q000150:complications
chemical_list: D008628:Mercury