Metallic embolism from intravenous injection of elemental mercury in a 27-year-old male for excision of multiple subcutaneous foreign body granuloma under general anesthesia

ABSTRACT

This is a case of 27-year-old male who sustained multiple metallic embolism from non-accidental self-injection of elemental mercury through the intravenous route. The patient allegedly self-injected at least twenty thermometers' worth of elemental mercury in a span of one year. The patient presented with generalized body fatigue, difficulty in position sense, distal hand weakness, tremors, labile mood, insomnia, and emotional instability. Physical examination showed multiple subcutaneous granulomas in the extremities at the sites of elemental mercury injection. Radiographic studies in the lungs, abdomen and extremities showed multiple dense spherules and pinpoint opacities indicative of metallic mercury embolism. Serum mercury levels were elevated. The patient underwent multiple hemodialysis sessions due to acute renal failure and tubular nephropathy secondary to mercury poisoning. The patient was eventually referred to the anesthesia department for excision of foreign body granulomas. Fentanyl, Propofol, Atracurium and Sevoflurane were used to induce and maintain anesthesia. Intra-operative course was unremarkable. Chelation therapy with DMSA (2,3-dimercaptosuccinic acid) was done postoperatively. Serum mercury was undetectable 20 days after surgery and chelation therapy. There were no postoperative complications. The patient was discharged well after 43 days of admission.