Acute onset parkinsonism after consumption of traditional Chinese medicine: A cause for vigilance.

ABSTRACT

Mercury poisoning is a rare yet critical toxicological emergency, typically associated with chronic exposure. This case report details the unusual presentation of acute parkinsonism in a 66-year-old woman who had been ingesting black pills, an unidentified kind of traditional Chinese medicine, obtained from a pirate radio source. The patient displayed symptoms such as acute onset frequent falls, unsteady gait, and slow movements, prompting a detailed medical examination. The patient's neurological assessment revealed classic parkinsonian features, including mask face, cogwheel rigidity, and bradykinesia. Subsequent laboratory investigations disclosed an elevated blood mercury level (47 µg/L), and imaging studies, including 99mTc-TRODAT-1 SPECT, confirmed bilateral putamina dysfunction consistent with secondary parkinsonism. Traditional medications of Parkinsonism provided minimal relief, leading to the introduction of chelation therapy with dimercaptosuccinic acid (DMSA), resulting in a significant improvement in symptoms following a 20-day course. The discussion emphasizes the distinctive clinical manifestations of organic and inorganic mercury poisoning, underscoring the delayed onset and central nervous system involvement in organic mercury toxicity. The unidentified black pills, known to exceed mercury standards, were identified as the likely source of mercury poisoning in this case. This report acknowledges the potential reversibility of certain causes of acute parkinsonism and highlights the importance of a thorough drug history and toxicology assessment in patients presenting with acute parkinsonism. This report also contributes to the existing understanding of mercury-induced parkinsonism and emphasizes the significance of timely intervention in managing similar cases.