Mercury intoxication is an uncommon cause of
hypertension in children and can mimic several other diseases, such as
pheochromocytoma and
vasculitis.
Mercury intoxication can present as a diagnostic challenge because levels of
catecholamines may be elevated, suggesting that the etiology is a
catecholamine-secreting
tumor. Once
acrodynia is identified as a primary symptom, a 24-hour urine
mercury level can confirm the diagnosis. Inclusion of
mercury intoxication in the differential diagnosis early on can help avoid unnecessary and invasive diagnostic tests and therapeutic interventions. We discuss a case of
mercury intoxication in a 3-year-old girl presenting with
hypertension and
acrodynia, without a known history of exposure.
Chelation therapy successfully treated our patient's
mercury intoxication. However, it was also necessary to concurrently treat her
hypertension and the
pain associated with her
acrodynia. Because there were no known risk factors for
mercury poisoning in this case, and because ritual use of
mercury is common in much of the United States, we recommend high clinical suspicion and subsequent testing in all cases of
acrodynia.