Case report: subcutaneous elemental mercury injection--clinical observations and implications for tissue disposal...

A 31-yr-old man presented to his general physician complaining of pain and swelling in the soft tissue of both hips. He initially denied knowledge of the etiology, but after elemental mercury droplets were expressed from the skin wounds by manual manipulation, he admitted that the source was self-administered sc injections. He did not provide a reason for this or give the time-frame of the injections. The areas of skin discoloration and soft tissue induration were completely excised and the wounds healed uneventfully. Blood levels of mercury declined gradually after excision. Examination of the resected skin and subcutis revealed subcutaneous abscesses containing droplets of elemental mercury, released easily when the abscesses were sectioned. Sections showed dark droplets of metallic mercury associated with necrosis and microabscess formation, with areas of foreign body giant cell reaction. Disposal of the residual tissues and mercury by incineration would release the volatile elemental mercury into the atmosphere, where it would subsequently be returned to earth in rain water, be converted to methyl mercury by microorganisms, and enter the food chain. The US Environmental Protection Agency has recommended caution in consuming foods containing methyl mercury and has provided guidelines for consuming foods believed to contain increased amounts of mercury. Mercury is readily available in the United States by over-the-counter sales to consumers, and in some cultures elemental mercury is used in ritualistic practices. Skin injection cases are infrequent, but histopathology laboratories should recognize this phenomenon and be prepared to dispose of Hg-contaminated tissues in an environmentally sound manner.