Subcutaneous elemental mercury injection and bone marrow failure: A fatal case

Objective: Elemental mercury (Hg) injection is rarely reported in literature, especially self-inflicted administration. Toxicity is primarily local with intense inflammation that may occur several months after the event. Systemic toxicity involves renal or neurological impairment and life-threatening conditions such as pulmonary embolism (1). Herein we describe an unusual fatal bone marrow failure after elemental mercury injection. Case report: A 46-year old woman presented to the Emergency Department complaining of weakness and slight fever. Blood tests showed severe anemia (Hb 2.9 g/dL), thrombocytopenia (PLT 2,000/mm3) and leukopenia (WBC 3180/mm3). A further inquiry revealed that, the patient, eight months before, had self-injected subcutaneously metal mercury into her left-forearm resulting in a massive abscess, drained 4 months later. Four months after the surgical intervention, an X-ray showed the persistence of metallic mercury at the injection site. Blood and urinary mercury levels were respectively 85 mcg/L (normal <4.5) and 914 mcg/L (normal <5). The metal speciation revealed the presence of elemental mercury. Samples of bone marrow detected a marked reduction of cell presence. After the treatment with meso-2,3-dimercaptosuccinic acid (DMSA), plasma Hg level decreased significantly, however liver function markers were altered. The patient presented a posterior reversible encephalitic syndrome which lasted few days. A treatment with immune suppressants and thrombopoietin receptor agonist was performed unsuccessfully. Six months later, the patient developed a severe fatal pulmonary infection. Conclusion: Pancytopenia has been rarely reported after elemental mercury injection. In the last 10 years, only one case of bone marrow failure following I.V. Hg administration was described (2). Nevertheless, in the circulatory system, elemental mercury can be transported to every organ with subsequent multi-organ toxicity. In our case a possible association between mercury toxicity and fatal bone marrow suppression could be suggested. 1. Friesenbichler J, Maurer-Ertl W et al. Auto-aggressive metallic mercury injection around the knee joint: a case report. BMC Surg 2011;11:31. 2. Priya N, Nagaprabhu VN et al. Aplastic anemia and membranous nephropathy induced by intravenous mercury. Indian J Nephrol 2012;22:451-4.