Acrodynia and CASPR2 Autoimmunity in Elemental Mercury Toxicity.
Sammy Taha, Alexander Sidlak, Meenu Krishnasamy et al.
✦ AI-curated · Sources linked
Case in brief
A 2-year-old girl presented with cough, congestion, and later developed sweating, fussiness, and a pruritic rash after exposure to elemental mercury from a household spill. Despite chelation therapy, she experienced persistent altered mental status. Testing revealed CASPR2 IgG antibodies, indicating autoimmune encephalitis. Treatment with intravenous immunoglobulin and corticosteroids led to gradual improvement in her mental status over several weeks.
What made this case unusual
The case highlights the rare association of CASPR2 autoimmunity with elemental mercury toxicity, leading to persistent neuropsychiatric symptoms despite mercury clearance.
Diagnostic / clinical pearl
Clinicians should consider autoimmune encephalitis in patients with persistent neurological symptoms following mercury exposure, even after successful chelation.
Why it matters
Recognizing the potential for autoimmune complications in mercury toxicity can guide appropriate diagnostic and therapeutic strategies, improving patient outcomes.