Membranous Nephropathy after Subcutaneous Mercury Injection

Area of Science:

• Nephrology
• Toxicology
• Dermatology

Background:

• Subcutaneous elemental mercury injection is generally considered low-risk for systemic toxicity.
• A case report details a patient who developed persistent membranous nephropathy following intentional subcutaneous elemental mercury injection.

Purpose of the Study:

• To report a rare case of systemic toxicity, specifically membranous nephropathy, resulting from subcutaneous elemental mercury injection.
• To discuss the potential pathophysiology and management of mercury-induced nephropathy.

Main Methods:

• A case study of a 21-year-old male with intentional subcutaneous elemental mercury injection into the forearm.
• Clinical presentation included nodularity, subsequent development of proteinuria, and diagnosis of membranous nephropathy.
• Interventions included attempted excision, rituximab treatment, surgical removal of mercury deposits, and chelation with succimer.

Main Results:

• The patient developed persistent membranous nephropathy with elevated proteinuria and urine protein to creatinine ratio despite treatment.
• Surgical excision of mercury deposits and chelation did not fully resolve the renal pathology.

Conclusions:

• Subcutaneous elemental mercury injection can lead to significant systemic toxicity, including membranous nephropathy.
• The pathophysiology may involve autoantibody and cytokine formation secondary to renal tubular injury.
• Surgical excision is the primary treatment, with chelation considered for systemic toxicity or ongoing exposure.