In the January/February issue of BCMJ, an interesting case of self-induced mercury poisoning was described.[1] Dr Albrecht outlined elegantly the assistance of the BC Poison Control Centre in the confirmation of the diagnosis and the institution of chelating therapy. He subsequently used the case as a teaching tool for medical students.

As for the diagnosis, it was provided by the patient in the form of a handwritten letter. In hindsight, the radiodense globules in the region of the stomach and the hepatic flexure of the colon shown in a chest PA view were felt to indicate heavy metal ingestion.

As for teaching purposes, sources of mercury poisoning in other cases should include fish consumption,[2] complementary and alternative medicines including Chinese herbal medicines,[3] and Ayurvedic medicines,[4] and others.[5]

The author reported in a patient with mercury poisoning presented with generalized dermatitis and abnormal liver function[6] similar to the present case. On the other hand, the prevalence of liver disease in a population from Minamata area (organic methyl mercury poisoning) was not increased compared with unexposed controls.[7]

Dr Albrecht’s case illustrates a multifaceted presentation of mercury poisoning.

—H.C. George Wong, MD
Vancouver

References

1. Albrecht  JE. Bilateral pneumonia: Lessons learned from an unusual presentation. BC Med J 2008;50:22-26.
2. Copes R, Palaty J, Lockitch G. Mercury exposure in British Columbia: Do we have a problem? BC Med J 2004;46:390.
3. Wong HCG. Mercury and Chinese herbal medicine. BC Med J 2004;46:440.
4. Gair R. Heavy metal poisoning from Ayurvedic medicines. BC Med J 2008;50:105.
5. Brodin E, Copes R, Mattman A, et al. Lead and mercury exposures: Interpretation and action. CMAJ 2007;176:59-63. 
6. Wong HCG. Acute generalized maculopapular eruption, abnormal liver function and elevated blood mercury level associated with Chinese herbal medicine. Can J Allergy Clin Immunol 2002;7:92-96.
7. Futusuka M, Kitano T, Nagano M, et al. An epidemiological study with risk analysis of liver diseases in general population living in a methylmercury polluted area. J Epidemiol Community Heath 1992;46:237-240.