A 41 y.o. male comes in with weight loss and spotty alopecia.

There is a clue on the CXR

does a close up help?

Another hint: from Dr. Levine

Our patient had acute mercury poisoning from an IV injection of mercury in a suicide attempt. Thermometers contain elemental mercury which has poor GI absorption but when injected can cause toxicity.   

While  evidence of mercury exposure was first described in Egypt in 1500 BC,  it was used for centuries in diuretics, laxatives and as an antibacterial.   It’s harmful health effects were described much later.  

For hundreds of years, hatters used mercuric nitrate( inorganic mercury)  on rabbit and beaver fur to separate the fur from the pelt. Beaver fur consists of outer guard hair and soft underfur.  The soft underfur, called wool,  has microscopic barbs and can be locked together forming a mat used to make felt.

  While in some places in the world it is still used; in the US most mercury was removed from the felt-making  process and hydrogen peroxide substituted.   The last case of “ mad hatter syndrome” was reported in the 1940s in the  US.  However, mercury poisoning still occurs  in the world from industrial pollution as at Minamata Bay in Japan where 27 million tons of mercury was dumped into the bay, contaminating fish and ultimately humans who  consumed  them.

erythrism from mercury poisoning in a child

The  symptoms of chronic mercury poisoning include  tremors, red fingers and cheeks and the loss of hair and teeth. Neurologic problems also occur with personality changes , peripheral neuropathy and deafness.

Mercury is the only liquid metal out of the 93 elements on the periodic table that are considered metals.  Nearly all metals are radiopaque and can be seen on plain radiographs except for aluminum.    This is why barium, titanium and iron are also visible on xray.

Our patient was treated with succimer and recovered.

FUN FACTS

Mercury’s chemical symbol is Hg which comes from the greek word hydragyros meaning "‘water’ and ‘silver’.

The caduceus often shown with the god Mercury is actually not the symbol of physicians; the staff of Asclepius is actually the symbol for physicians( one snake). The staff of Mercury is called the caduceus meaning herald’s wand, since he is the messenger of the gods and also the patron of thieves.