Self-injection with mercury

Abstract

A 27.year-old doorman at a local hotel casino presented to the accident and emergency department in December 1991. He complained of a painful swelling on the flexor aspect of his forearm. Examination revealed a tender 4 x 5 cm fluctuant swelling. There were no local puncture sites or wounds. The ‘abscess’ was incised under local anaesthesia. The doctor was surprised when mercury was drained. A forearm radiograph showed more mercury in the wound (Figure I), and a chest radiograph demonstrated mercuric emboli throughout both lungs (Figure 2). Over the next 2 months serial measurements of blood and urine mercury levels were raised, but not to toxic levels. Respiratory function tests were normal and 24 h urine collection revealed normal creatinine clearance. At 1 week after presentation the mercuric swelling on his right forearm was completely excised and closed primarily, under general anaesthesia. At I month after presentation he attended the department complaining of flu-like symptoms and headache. A skull radiograph then showed specks of mercury, suggesting the possibility of intracranial deposits implying that the mercury had passed through his lungs to the systemic circulation. He was given penicillamine. He remained well and continued to revel in the medical attention and to deny all knowledge of how the mercury had entered his body! He is a keen body builder of 1.90 m in height and weighs 107 kg. He says his occupation demands a certain stature and strength. In February 1992 he again presented to the accident and emergency department, on this occasion with a bullet wound on his forehead. Computerized tomography demonstrated a large frontal haematoma and he was referred to the neurosurgeons for wound excision and retrieval of a hand gun bullet. He declined to describe how either incident had occurred.