Thrombocytopenia Associated with Elemental Mercury Poisoning in Two Siblings - Connecticut, July 2022

Area of Science:

• Toxicology
• Pediatrics
• Environmental Health

Background:

• Elemental mercury exposure can lead to severe health consequences, particularly in children.
• Thrombocytopenia and mucositis are critical indicators of potential mercury poisoning.
• Prompt diagnosis and intervention are essential for favorable outcomes.

Purpose of the Study:

• To highlight the clinical presentation and management of elemental mercury toxicity in pediatric patients.
• To emphasize the importance of considering environmental toxic exposures in cases of unexplained severe thrombocytopenia.
• To underscore the need for interagency collaboration in managing household mercury contamination.

Main Methods:

• Case report of two siblings with severe thrombocytopenia following elemental mercury exposure.
• Review of clinical management including supportive care, chelation therapy, and specific treatments for thrombocytopenia.
• Environmental assessment and decontamination procedures.

Main Results:

• Both siblings presented with petechial rash, oral mucositis, and severe thrombocytopenia.
• The younger sibling required prolonged hospitalization and multiple treatments, including intravenous immune globulin (IVIG), steroids, and romiplostim.
• Successful home decontamination and treatment of other family members were achieved through interagency collaboration.

Conclusions:

• Elemental mercury toxicity should be considered in children presenting with severe thrombocytopenia and mucositis.
• Environmental exposure assessment is critical when multiple individuals in close contact exhibit similar symptoms.
• Public health initiatives promoting awareness of elemental mercury risks are vital for early detection and prevention.