title: Auto-aggressive metallic mercury injection around the knee joint: a case report.
abstract: BACKGROUND
  Accidental or intentional subcutaneous and/or intramuscular injection of metallic mercury is an uncommon form of poisoning. Although it does not carry the same risk as mercury vapour inhalation, it may cause destructive early and late reactions.
  
  
  METHODS
  Herein we present the case of a 29-year-old male patient who developed an obsessive-compulsive disorder causing auto-aggressive behaviour with injection of elemental mercury and several other foreign bodies into the soft tissues around the left knee about 15 years before initial presentation. For clinical examination X-rays and a CT-scan of the affected area were performed. Furthermore, blood was taken to determine the mercury concentration in the blood, which showed a concentration 17-fold higher than recommended. As a consequence, the mercury depots and several foreign bodies were resected marginally.
  
  
  CONCLUSIONS
  Blood levels of mercury will decrease rapidly following surgery, especially in combination with chelating therapy. In case of subcutaneous and intramuscular injection of metallic mercury we recommend marginal or wide excision of all contaminated tissue to prevent migration of mercury and chronic inflammation. Nevertheless, prolonged clinical and biochemical monitoring should be performed for several years to screen for chronic intoxication.
authors.affiliation: Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, Graz, Austria.
authors.forename: Joerg
authors.initials: J
authors.lastname: Friesenbichler
authors.forename: Werner
authors.initials: W
authors.lastname: Maurer-Ertl
authors.forename: Patrick
authors.initials: P
authors.lastname: Sadoghi
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wolf
authors.forename: Andreas
authors.initials: A
authors.lastname: Leithner
mesh_terms: D000328:Adult; D000374:Aggression; D006801:Humans; D007267:Injections; D007719:Knee Joint; D008297:Male; D008628:Mercury / Q000008:administration & dosage* / Q000097:blood; D008630:Mercury Poisoning / Q000209:etiology / Q000601:surgery*; D009771:Obsessive-Compulsive Disorder / Q000150:complications*; D016728:Self-Injurious Behavior / Q000209:etiology*
chemical_list: D008628:Mercury
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