Abstract
Introduction: Elemental mercury poisoning is a common cause of occupational disease, it can trigger gastrointestinal, renal, visual and neuropsychiatric symptoms such as mercurial erethism and movement disorders (ataxia, tremor, myoclonias and parkinsonism), among others.
Case presentation: 34-year-old male with occupational exposure to mercury vapors in a confined space and without adequate use of personal protective equipment. Among his manifestations, central and peripheral toxicity is highlighted by neuropsychiatric symptoms (mercurial erethism) and movement disorder (incapacitating parkinsonism). Diagnosis is confirmed with very high levels of mercury in blood and urine 24 hours. He received chelation therapy, carbidopa, levodopa and N-acetylcysteine, achieving a significant decrease in body levels and complete resolution of symptoms (1 year of follow-up).
Discussion: Mercury is a highly toxic metal for the human brain, it has the capacity to generate a direct toxic effect on the basal ganglia and the granular cell layer of the cerebellum, alters calcium and glutamate homeostasis, releases proinflammatory cytokines and increases local oxidative stress with mitochondrial dysfunction and excitotoxicity on dopaminergic neurons leading to the development of movement disorders (parkinsonism) and neuropsychiatric manifestations. Diagnosis is confirmed by measuring mercury levels in body tissues and specific treatment is based on exposure withdrawal, chelation and adjuvant therapies.
Conclusions: In patients with occupational exposure to mercury and development of neuromotor symptoms, the diagnosis of intoxication should be suspected and timely treatment should be initiated to avoid permanent sequelae.
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