Bradberry S M, Feldman M A, Braithwaite R A, Shortland-Webb W, Vale J A
City Hospital NHS Trust, Birmingham, United Kingdom.
J Toxicol Clin Toxicol. 1996;34(2):209-16. doi: 10.3109/15563659609013772.
Injection of elemental mercury is rare and only some 72 cases have been reported in the literature over the period 1923-1995. Direct subcutaneous injection or extravasation of mercury injected into blood vessels can produce local granulomata and abscesses. Unless intravascular mercury injection has occurred, clinical signs of mercury toxicity are usually absent though four cases of systemic toxicity have been reported following isolated subcutaneous injection without evidence of elemental mercury dissemination.
We report a further 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 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 operative intervention as he remained asymptomatic. Chelation therapy was not instituted. Serum and urine mercury concentrations were measured for six years after presentation.
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 monitoring of blood and urine mercury concentrations.
注射元素汞的情况罕见，在1923年至1995年期间，文献中仅报道了约72例。直接皮下注射或注入血管的汞外渗可产生局部肉芽肿和脓肿。除非发生血管内汞注射，否则通常不会出现汞中毒的临床症状，不过曾有4例在孤立的皮下注射后出现全身毒性的报道，且无元素汞播散的证据。
我们报告了一例19岁男性因在现役期间左肘前窝出现一个有压痛且不断增大的肿块达8个月而入院，该肿块是由一枚含汞子弹皮下注射所致，随后形成肉芽肿。已尝试从一枚疑似含汞弹头的子弹中取出汞，但未取净，由于患者仍无症状，故拒绝进一步手术干预。未进行螯合疗法。在患者就诊后六年内对其血清和尿液汞浓度进行了检测。
我们建议，对于皮下注射金属汞的病例，应在X线控制下完整切除肉芽肿，并对血液和尿液汞浓度进行连续监测。
