Erethism Mercurialis and Reactions to Elemental Mercury

Mercury is an underrecognized cause of heavy metal poisoning. Typically, mercury exposure occurs though consumption of methylmercury in seafood or acute inhalation of elemental mercury vapors, with other routes of exposure being uncommon. We describe a case of mercury toxicity resulting from intentional injection of liquid mercury into the right antecubital fossa in a suicide attempt. Mercury poisoning may present with characteristic neuropsychologic signs and symptoms. Increasing anxiety, depression, tremors, irritability, and difficulty concentrating coupled with blood mercury levels higher than 100 μg/L and urine mercury levels of 477 μg/g led to the diagnosis of erethism mercurialis, a constellation of neuropsychologic signs and symptoms including restlessness, irritability, insomnia, emotional lability, difficulty concentrating, and impaired memory. Skin reactions associated with contact to elemental mercury are rare. However, this case presented with a mercury granuloma. Hives and dermatitis have been observed following accidental contact with inorganic mercury compounds.