title: Subcutaneous injection of metallic mercury.
abstract: Deliberate self-injection of metallic mercury into subcutaneous tissue is uncommon. A 41-year-old lady with a history of schizophrenia was admitted to our hospital after deliberate injection of metallic mercury into her right wrist and antecubital fossa. Physical examination was unremarkable except for the injection marks over right antecubital fossa and wrist. The presence of subcutaneous mercury deposits in her right elbow and wrist was confirmed by X-rays and ultrasound scan. Three days later, erythema, swelling, induration and tenderness were seen over the injection sites. At the operation on day 9, mercury streaks were seen within the brachialis muscle belly, surrounded by friable necrotic tissues along the tract. A similar picture was noted in her right wrist. The necrotic tissues and mercury streaks were removed. The patient had been unco-operative and she only received incomplete treatment with dimercaprol and 2,3-dimercaptosuccinic acid. Her total blood mercury level (normal < 50 nmol/L) decreased from 101-151 nmol/L in the first two weeks to 42 nmol/L 3 months later. Her 24-hour urinary mercury excretion (normal < 10 nmol) changed from 55.7-209.5 nmol in the first 7 weeks to 125.4 nmol 3 months later. This case illustrates that soft tissue metallic mercury can produce local necrosis and may allow continuous absorption with persistent elevations in blood and urinary mercury levels. Therefore, early surgical removal of subcutaneous mercury deposits is required to prevent local complications and minimize the risk of systemic absorption and toxicity.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
authors.forename: Y O Y
authors.initials: YO
authors.lastname: Soo
authors.forename: C H
authors.initials: CH
authors.lastname: Wong
authors.forename: J F
authors.initials: JF
authors.lastname: Griffith
authors.forename: T Y K
authors.initials: TY
authors.lastname: Chan
mesh_terms: D000328:Adult; D001132:Arm / Q000000981:diagnostic imaging; D002614:Chelating Agents / Q000627:therapeutic use; D004112:Dimercaprol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008628:Mercury / Q000097:blood / Q000652:urine; D008630:Mercury Poisoning / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D009336:Necrosis; D011859:Radiography; D012646:Self Administration; D040521:Subcutaneous Tissue / Q000473:pathology / Q000601:surgery; D004113:Succimer / Q000627:therapeutic use; D014953:Wrist / Q000000981:diagnostic imaging
chemical_list: D002614:Chelating Agents; D004112:Dimercaprol; D004113:Succimer; D008628:Mercury