A Diagnostic and Management Challenge in Severe Fatal Mercury Poisoning Secondary to Homeopathic Medications

We present a case of a patient known to have rheumatoid arthritis with severe nephrotic syndrome very likely due to chronic mercury poisoning. She was known to have rheumatoid arthritis for 10 years. Mercury poisoning was attributed to homeopathic Ayurvedic medicine which she took for arthritic pain. It is highly likely that the Ayurvedic medications contained high concentrations of mercury. The patient presented with worsening breathlessness on exertion and global pitting oedema. Initial investigations suggested a nephrotic syndrome of unknown aetiology. The patient's kidney function worsened, and she developed a hospital-acquired infection and deteriorated further with type 1 respiratory failure. Despite attempted continuous veno-venous hemodiafiltration, the patient unfortunately passed away secondary to end-stage renal failure caused by chronic severe mercury poisoning. This case report adds to the concerns regarding the potential risks of unregulated Ayurvedic medications without clear instructions from a trained medical professional. It highlights the importance of taking a detailed drug history on the first encounter with the patient.