Neurological and psychiatric symptoms due to mercury intoxication in a family from Iraq

Objectives: A case of a seldomly occurring mercury intoxication in a family due to a mercury containing creme is presented here. Material and Methods: A four year old child from Iraq was admitted to our institution with a first seizure and a history of adynamia, insomnia and excitability. A significant weight loss was reported as well. During hospitalisation the child presented with persistent arterial hypertension and tachycardia. Results: With regards to arterial hypertension the urinary catecholamine concentration was measured und found to be above normal levels which could probably occur due to a phaeochromozytoma. Sonographical results of the kidney and the abdomen were negative as well as a MRI of the abdomen and a MIBG scintigraphic study of the kidney (DD: neuroblastoma). Evaluation of the seizure showed a normal EEG and signs of a toxic encephalopathy in cranial MRI. Consequently because of the combination of above mentioned symptoms an investigation for a mercury intoxication was undertaken showing increased mercury levels in blood and urine. Subsequently other family members showed increased mercury levels, too. As a reason for this a privately produced and illegally distributed crème with a content of 27% Hg was found, which was used in the time between April and June 2004. An antihypertensive therapy and the application of dimercapto-1-propansulficacid (DMPS) was started. Under this therapy clinical symptoms improved. Conclusions: Above mentioned case shows that in differential diagnosis a mercury intoxication with exposure to mercury in the past has to be kept in mind when neurological and cardiovascular symptoms occur together. The abuse of vanishing crèmes can be found commonly in eastern Europe and arabic countries and if clinical symptoms can be found it should explicitly be asked for it. Furthermore it should be kept in mind, that a mercury intoxication can present with similar symptoms and laboratory changes in urine as a phaeochromocytoma.