title: Elemental mercury poisoning presenting as hypertension in a young child.
abstract: Mercury intoxication is an uncommon cause of hypertension in children and can mimic several other diseases, such as pheochromocytoma and vasculitis. Mercury intoxication can present as a diagnostic challenge because levels of catecholamines may be elevated, suggesting that the etiology is a catecholamine-secreting tumor. Once acrodynia is identified as a primary symptom, a 24-hour urine mercury level can confirm the diagnosis. Inclusion of mercury intoxication in the differential diagnosis early on can help avoid unnecessary and invasive diagnostic tests and therapeutic interventions. We discuss a case of mercury intoxication in a 3-year-old girl presenting with hypertension and acrodynia, without a known history of exposure. Chelation therapy successfully treated our patient's mercury intoxication. However, it was also necessary to concurrently treat her hypertension and the pain associated with her acrodynia. Because there were no known risk factors for mercury poisoning in this case, and because ritual use of mercury is common in much of the United States, we recommend high clinical suspicion and subsequent testing in all cases of acrodynia.
authors.affiliation: Department of Pediatrics, Rhode Island Hospital, Providence, RI 02903, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Brannan
authors.forename: Sharon
authors.initials: S
authors.lastname: Su
authors.forename: Brian K
authors.initials: BK
authors.lastname: Alverson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000170:Acrodynia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D016902:Air Pollution, Indoor / Q000009:adverse effects; D002395:Catecholamines / Q000032:analysis; D002614:Chelating Agents / Q000627:therapeutic use; D015913:Chelation Therapy; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects; D005076:Exanthema / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000628:therapy; D017669:Mercury Compounds / Q000009:adverse effects* / Q000652:urine; D004113:Succimer / Q000627:therapeutic use; D013610:Tachycardia / Q000209:etiology
chemical_list: D002395:Catecholamines; D002614:Chelating Agents; D017669:Mercury Compounds; D004113:Succimer