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Mercury intoxication resembling pediatric rheumatic diseases: case series and literature review

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Abstract

Mercury is the only metal that remains in liquid form at the room temperature. It is a very toxic metal and even short-term exposure can lead to poisoning. Mercury intoxication can affect many systems such as skin, cardiovascular, genitourinary, central and peripheral nervous, respiratory, and musculoskeletal system. Consequently, the diagnosis of mercury intoxication can be challenging due to its non-specific and multisystemic presentation. Herein, we report five pediatric cases with mercury intoxication from two families that were initially misdiagnosed as rheumatic disorders. We also performed a literature review about pediatric cases with mercury intoxication to investigate the clinical findings in children, the source of intoxication, and the current treatment preferences. As in our cases, reported patients were previously misdiagnosed as various infectious and/or rheumatic diseases before the diagnosis of mercury intoxication was established. A delay in diagnosis and treatment can cause serious morbidities and even mortality. We report this case series to emphasize the multisystemic presentation of mercury intoxication, and to remind and provide clues for physicians to recognize this rare toxicologic syndrome.

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Authors and Affiliations

  1. Cerrahpasa Medical School, Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Mehmet Yildiz, Amra Adrovic, Aybuke Gurup, Oya Koker, Sezgin Sahin, Kenan Barut & Ozgur Kasapcopur

  2. Cerrahpasa Medical School, Department of Pediatric Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Esra Karabag Yilmaz & Nur Canpolat

  3. Cerrahpasa Medical School, Department of Pediatric Endocrinology, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Yavuz Ozer

  4. Cerrahpasa Medical School, Department of Nutrition and Metabolism, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Ertugrul Kiykim

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  1. Mehmet Yildiz
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Contributions

OK, KB, and NC conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. MY, AA, AG, EKY, YO, OK, SS, and EK performed the literature review. MY and AA wrote initial manuscript. All authors approved the final manuscript as submitted and agreed to be responsible for all aspects of the work. All co-authors take full responsibility for the integrity of the case series and literature review.

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Correspondence to Ozgur Kasapcopur.

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Yildiz, M., Adrovic, A., Gurup, A. et al. Mercury intoxication resembling pediatric rheumatic diseases: case series and literature review. Rheumatol Int 40, 1333–1342 (2020). https://doi.org/10.1007/s00296-020-04589-2

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