Nguyen-Dang Khoa, Dau-Nguyen Anh-Thu, Tran-Ngoc Nguyen, Duong-Minh Ngoc, Dang-Vu Thong, Nguyen-Ngoc Sang, Vu-Hoai Nam, Le-Quoc Hung
Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam.
Department of Pulmonary Medicine, Cho Ray Hospital, Ho Chi Minh, Vietnam.
Medicine (Baltimore). 2024 Dec 13;103(50):e41013. doi: 10.1097/MD.0000000000041013.
Among 3 forms of mercury, elemental mercury vapor presents the highest threat due to its potential to cause acute pneumonitis. The management of acute mercury vapor poisoning remains unclear, particularly in acute lung injury. We present a case of mercury vapor poisoning resulting from the heating of cinnabar, successfully treated with high-dose corticosteroids and chelation therapy, and follow-up over 6 months.
A 47-year-old female patient was admitted to the Emergency Department due to dyspnea, chest tightness, and weakness following cinnabar heating.
Upon admission, she presented with tachypnea and respiratory failure. During the first 5 days, the respiratory failure rapidly progressed, requiring high-flow nasal cannula support, and showed no improvement with broad-spectrum intravenous (IV) antibiotics and 80 mg daily IV methylprednisolone. Total blood and urinary mercury levels were measured to confirm the diagnosis.
Upon confirmation of acute pneumonitis due to mercury vapor poisoning, the patient was administered high-dose methylprednisolone (500 mg IV per day) and chelation therapy, which led to subsequent improvement.
Six months after discharge, the patient completely recovered, as evidenced by chest imaging and pulmonary function tests.
Heating elemental mercury can cause pneumonitis, leading to acute respiratory failure. A detailed history is crucial for diagnosis. High-dose methylprednisolone should be considered in patients who do not respond to lower doses. Patients should be monitored afterward to detect residual pulmonary fibrotic changes.
在三种汞的形态中，元素汞蒸气因其有可能导致急性肺炎而构成最高威胁。急性汞蒸气中毒的治疗方法仍不明确，尤其是在急性肺损伤方面。我们报告一例因加热朱砂导致的汞蒸气中毒病例，该病例通过大剂量皮质类固醇和螯合疗法成功治愈，并进行了6个月的随访。
一名47岁女性患者因加热朱砂后出现呼吸困难、胸闷和乏力而入住急诊科。
入院时，她表现为呼吸急促和呼吸衰竭。在最初的5天里，呼吸衰竭迅速进展，需要高流量鼻导管支持，且广谱静脉抗生素和每日80毫克静脉注射甲泼尼龙治疗均无改善。检测全血和尿汞水平以确诊。
确诊为汞蒸气中毒导致的急性肺炎后，给予患者大剂量甲泼尼龙（每日500毫克静脉注射）和螯合疗法，随后病情有所改善。
出院6个月后，胸部影像学和肺功能检查显示患者已完全康复。
加热元素汞可导致肺炎，进而引起急性呼吸衰竭。详细的病史对诊断至关重要。对低剂量治疗无反应的患者应考虑使用大剂量甲泼尼龙。此后应对患者进行监测，以检测残留的肺纤维化改变。
