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Mercury poisoning from home gold amalgam extraction

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This is the first Australian report of confirmed minimal change disease with nephrotic syndrome, which occurred in a 62-year-old man who inhaled mercury vapour in his home. This case highlights the immediate and delayed effects of such poisoning on multiple organs. Prompt and sometimes prolonged treatment may prevent long-term damage.

Clinical record

A 62-year-old man first presented to his general practitioner complaining of a cough, dyspnoea and lethargy for which he was prescribed oseltamivir phosphate, as his symptoms were presumed to indicate influenza. He re-presented 2 days later with worsening dyspnoea, at which point he revealed a history of mercury exposure. He had attempted to extract gold from an amalgam containing mercury by heating the amalgam in an aluminium pan inside his home. He was exposed for 3 hours — initially, to fumes, and subsequently, through direct skin contact as he attempted to clean up some spilt liquid amalgam. The windows were open and he used a tea towel covering his nose as protection from the fumes. A chest x-ray showed extensive alveolar shadowing consistent with pneumonitis. He was admitted to a regional hospital, and was given supplemental oxygen and antibiotics. His blood mercury level was 5933 nmol/L (level of concern, > 70 nmol/L). On the advice of a toxicologist, he was transferred to a tertiary hospital for chelation therapy.