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