A Case of Exfoliative Dermatitis with Renal and Bone Marrow Failires due to Topical Metalic Mercury

Kim, Bo Hyung; Hong, Hwang Pyo; Kim, Byung Kee; Kim, Chung Won; Houh, Won

Abstract

Mercury had been an important constituent of the remedial drugs for last few centuries, but substantially replaced by more specific and effective mordern medicines. However, metalic mercury, tbe vestige of the last decades, has still been employed for the patients of scabies by the herbal doctors in Korea. Therefore, we have often experienced patients with such complications as exfoliative dermatitis following topical applications of metalic mercury or inhalation of the vapor. There are three major toxic chernical forms of mercury, such as metalic (ele- mental) mercury vapor, salts of the mercury, and organic mercur.'als. Metailc mercury is the most volatile of the inorganic forms of the metal, Inhalation of the vapor of the metalic mercury is very toxic, but ingestion of the globular forms is rarely harmful. Acute mercury poison.ng due to topical mercurials is very rare. This case was a such patient who showed the mercury poisoning can result from the percutaneous absorption of topically applied mercury. The patient was an 11 year-old schoolboy with scabies. Three days after topical applications on the whole body with the mixture of rneta,lic rnercury, phosphorus and perilla oil, as prescribed by a herbal doctor, he was suffered from headache, fever, facial flushing, sore throat, a,nd stomatitis for a few days, and then followed by exfoliative dermatitis, renal and bone marrow fa'.lures. However, bone marrow failure due to mercury was very rarely described in the literatures. Virtually, the whole body was covered by thick scales on the dirty greyish pigmented or erytheinatoas Cohfluent payules. It whs oozing on the external genital area, and all nails were spontaneously extracted. Tbe findings of renal failures included puffy face, ascites, BUN 92. 8 mg/dl, serum creatinine 7. 3 mg/dl. creat.nine clearance 12rnl/min., proteinuria, rnicro and gross hematuria, and non or poor visualizations of IVP. The peak in severity was at about 50 days after onset and bacame normal except mild proteinuria at about 70 days after onset. The findings of aplastic anemia were shown by pancytopenia(Hb 7. 6g/dl, WBC 1, 700, seg. neutro. 18%, lympho. 40% mono. 26%, eosino. 16%, Hct25%, thrombocytes 40, 000, RBC 3, 000, 000, reticulocytes 0. 1%) and about 20 per cent of the cellularity in bone marrow aspiration from about 70 to 90 days after onset. In fact, the aplastic anemia was coincided with nasal bleeding, staphylococcal septisema, and staphylococcal pustulation at the site of IM injection. However, the levels of onset 80 day-urine and blood rnercury were high: 208 ug/1. (norm.alless than 100 ug/l)in urine, and 126. 3 ug/100g (normal less than 5 ug/100g) in blood.

A Case of Exfoliative Dermatitis with Renal and Bone Marrow Failires due to Topical Metalic Mercury

Abstract

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