Auto-aggressive metallic mercury injection around the knee joint: a case report

Herein we present the case of a 29-year-old male patient who developed an obsessive-compulsive disorder causing auto-aggressive behaviour with injection of elemental mercury and several other foreign bodies into the soft tissues around the left knee about 15 years before initial presentation. For clinical examination X-rays and a CT-scan of the affected area were performed. Furthermore, blood was taken to determine the mercury concentration in the blood, which showed a concentration 17-fold higher than recommended. As a consequence, the mercury depots and several foreign bodies were resected marginally.Blood levels of mercury will decrease rapidly following surgery, especially in combination with chelating therapy. In case of subcutaneous and intramuscular injection of metallic mercury we recommend marginal or wide excision of all contaminated tissue to prevent migration of mercury and chronic inflammation. Nevertheless, prolonged clinical and biochemical monitoring should be performed for several years to screen for chronic intoxication.There are several reports in the literature concerning mercury intoxication with Wolfgang Amadeus Mozart as the most prominent possible victim [1]. In most cases, mercury is predominantly absorbed by the respiratory system, particularly by inhalation of the vapour, which is produced at room temperature [2-6]. Following inhalation, mercury damages the lung tissue. Furthermore, a large part of mercury is absorbed by the pulmonary vasculature and distributed to further organs. Mercury also passes the blood-brain barrier and remains in the nervous system before being oxidized [6-8].Subcutaneous and intramuscular injection of elemental mercury is of rare occurrence, although in most cases it may be injected voluntarily in the setting of attempted suicide or in context of psychiatric diseases [4,5,7,9-16]. Prasad et al. [10] reported the subcutaneous injection of mercury for ethnic reasons and Lech and Goszcz [3] related a case of mercury