ELEMENTAL MERCURY-INDUCED SKIN GRANULOMA - A CASE-REPORT AND REVIEW OF THE LITERATURE

Background: Injection of elemental mercury is rare and only some 72 ca ses have been reported in the literature over the period 1923-1995. Di rect subcutaneous injection or extravasation of mercury injected into blood vessels can produce local granulomata and abscesses. Unless intr avascular mercury injection has occurred, clinical signs of mercury to xicity are usually absent though four cases of systemic toxicity have been reported following isolated subcutaneous injection without eviden ce of elemental mercury dissemination. Case Report: We report a furthe r case of subcutaneous injection by gunshot of elemental mercury, with subsequent granuloma formation, in a 19-year-old man who was admitted with an eight month history of a tender enlarging mass in his left an tecubital fossa. three months before the onset of symptoms he had been shot in the left antecubital fossa, while on active military service. Surgical removal of mercury from a presumed mercury-tipped bullet was undertaken but was incomplete and the patient declined further operat ive intervention as he remained asymptomatic. Chelation therapy was no t instituted. Serum and urine mercury concentrations were measured for six years after presentation. Conclusions: We recommend that cases of subcutaneous metallic mercury injection should be managed by complete surgical excision of the granuloma under X ray control and serial mon itoring of blood and urine mercury concentrations.