Yıl: 2023 Cilt: 65 Sayı: 1 Sayfa Aralığı: 170 - 175 Metin Dili: İngilizce DOI: 10.24953/turkjped.2022.249 İndeks Tarihi: 16-05-2023

Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl

Öz:
Background. The clinical presentation of mercury (Hg) intoxication may mimic rheumatic diseases. Hg exposure is associated with systemic lupus erythematosus (SLE)-like disease in genetically susceptible rodents and Hg is among the environmental factors in the development of SLE in humans. Herein, we presented a case with clinical and immunological features suggestive of SLE but diagnosed with Hg intoxication. Case. A thirteen-year-old female with myalgia, weight loss, hypertension and proteinuria was referred to our clinic for the evaluation of possible SLE. Physical examination of the patient was unremarkable except for a cachectic appearance and hypertension, laboratory investigation revealed positive anti-nuclear antibody, dsDNA antibody and hypocomplementemia with nephrotic range proteinuria. Inquiry for toxic exposures revealed a continuous exposure to an unknown silverly shiny liquid for a month which was thought to be Hg. Due to the fulfillment of Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE, a percutaneous kidney biopsy was performed whether proteinuria resulted because of the Hg exposure or flare of lupus nephritis. Blood and 24-hour urine Hg levels were high, and no findings associated with SLE were observed in the examination of the kidney biopsy. The patient was diagnosed with Hg intoxication and, clinical and laboratory findings, including hypocomplementemia, positive ANA and anti-dsDNA antibody, improved with chelation therapy. Also, no findings associated with SLE were observed in the follow-up of the patient. Conclusions. In addition to the toxic effects, Hg exposure may cause autoimmune features. As far as we know, this is the first-time Hg exposure was associated with hypocomplementemia and anti-dsDNA antibody in a patient. Also, this case highlights the inconvenience of the use of classification criteria for diagnostic purposes.
Anahtar Kelime: autoimmunity mercury nephritis systemic lupus erythematosus

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık
0
0
0
  • 1. Smith EMD, Lythgoe H, Midgley A, Beresford MW, Hedrich CM. Juvenile-onset systemic lupus erythematosus: update on clinical presentation, pathophysiology and treatment options. Clin Immunol 2019; 209: 108274. https://doi.org/10.1016/j. clim.2019.108274
  • 2. Barbhaiya M, Costenbader KH. Environmental exposures and the development of systemic lupus erythematosus. Curr Opin Rheumatol 2016; 28: 497- 505. https://doi.org/10.1097/BOR.0000000000000318
  • 3. Counter SA, Buchanan LH. Mercury exposure in children: a review. Toxicol Appl Pharmacol 2004; 198: 209-230. https://doi.org/10.1016/j.taap.2003.11.032
  • 4. Bjørklund G, Peana M, Dadar M, Chirumbolo S, Aaseth J, Martins N. Mercury-induced autoimmunity: drifting from micro to macro concerns on autoimmune disorders. Clin Immunol 2020; 213: 108352. https://doi.org/10.1016/j. clim.2020.108352
  • 5. Petri M, Orbai A-M, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64: 2677-2686. https://doi.org/10.1002/art.34473
  • 6. Groot N, de Graeff N, Avcin T, et al. European evidence-based recommendations for diagnosis and treatment of childhood-onset systemic lupus erythematosus: the SHARE initiative. Ann Rheum Dis 2017; 76: 1788-1796. https://doi.org/10.1136/ annrheumdis-2016-210960
  • 7. Parks CG, Cooper GS, Nylander-French LA, et al. Occupational exposure to crystalline silica and risk of systemic lupus erythematosus: a populationbased, case-control study in the southeastern United States. Arthritis Rheum 2002; 46: 1840-1850. https:// doi.org/10.1002/art.10368
  • 8. Dahlgren J, Takhar H, Anderson-Mahoney P, Kotlerman J, Tarr J, Warshaw R. Cluster of systemic lupus erythematosus (SLE) associated with an oil field waste site: a cross sectional study. Environ Health 2007; 6: 8. https://doi.org/10.1186/1476- 069X-6-8
  • 9. Crowe W, Allsopp PJ, Nyland JF, et al. Inflammatory response following in vitro exposure to methylmercury with and without n-3 long chain polyunsaturated fatty acids in peripheral blood mononuclear cells from systemic lupus erythematosus patients compared to healthy controls. Toxicol In Vitro 2018; 52: 272-278. https:// doi.org/10.1016/j.tiv.2018.05.008
  • 10. Crowe W, Allsopp PJ, Watson GE, et al. Mercury as an environmental stimulus in the development of autoimmunity - a systematic review. Autoimmun Rev 2017; 16: 72-80. https://doi.org/10.1016/j. autrev.2016.09.020
  • 11. Silva IA, Nyland JF, Gorman A, et al. Mercury exposure, malaria, and serum antinuclear/ antinucleolar antibodies in Amazon populations in Brazil: a cross-sectional study. Environ Health 2004; 3: 11. https://doi.org/10.1186/1476-069X-3-11
  • 12. Gardner RM, Nyland JF, Silva IA, Ventura AM, de Souza JM, Silbergeld EK. Mercury exposure, serum antinuclear/antinucleolar antibodies, and serum cytokine levels in mining populations in Amazonian Brazil: a cross-sectional study. Environ Res 2010; 110: 345-354. https://doi.org/10.1016/j.envres.2010.02.001
  • 13. Somers EC, Richardson BC. Environmental exposures, epigenetic changes and the risk of lupus. Lupus 2014; 23: 568-576. https://doi. org/10.1177/0961203313499419
  • 14. Lee HT, Wu TH, Lin CS, et al. The pathogenesis of systemic lupus erythematosus - From the viewpoint of oxidative stress and mitochondrial dysfunction. Mitochondrion 2016; 30: 1-7. https:// doi.org/10.1016/j.mito.2016.05.007
  • 15. Bridges CC, Zalups RK. The aging kidney and the nephrotoxic effects of mercury. J Toxicol Environ Health B Crit Rev 2017; 20: 55-80. https://doi.org/10. 1080/10937404.2016.1243501
  • 16. Qin AB, Su T, Wang SX, Zhang F, Zhou F, Zhao MH. Mercury-associated glomerulonephritis: a retrospective study of 35 cases in a single Chinese center. BMC Nephrol 2019; 20: 228. https://doi. org/10.1186/s12882-019-1413-z
  • 17. Kısaarslan AP, Sözeri B, Baştuğ F, et al. Elemental mercury intoxication in 7 patients admitted to a pediatric rheumatology clinic. Turk J Pediatr 2019; 61: 786-790. https://doi.org/10.24953/ turkjped.2019.05.021
  • 18. Yildiz M, Adrovic A, Gurup A, et al. Mercury intoxication resembling pediatric rheumatic diseases: case series and literature review. Rheumatol Int 2020; 40: 1333-1342. https://doi.org/10.1007/s00296- 020-04589-2
APA Kısaoğlu H, Baba O, KALYONCU M (2023). Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. , 170 - 175. 10.24953/turkjped.2022.249
Chicago Kısaoğlu Hakan,Baba Ozge,KALYONCU MUKADDES Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. (2023): 170 - 175. 10.24953/turkjped.2022.249
MLA Kısaoğlu Hakan,Baba Ozge,KALYONCU MUKADDES Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. , 2023, ss.170 - 175. 10.24953/turkjped.2022.249
AMA Kısaoğlu H,Baba O,KALYONCU M Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. . 2023; 170 - 175. 10.24953/turkjped.2022.249
Vancouver Kısaoğlu H,Baba O,KALYONCU M Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. . 2023; 170 - 175. 10.24953/turkjped.2022.249
IEEE Kısaoğlu H,Baba O,KALYONCU M "Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl." , ss.170 - 175, 2023. 10.24953/turkjped.2022.249
ISNAD Kısaoğlu, Hakan vd. "Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl". (2023), 170-175. https://doi.org/10.24953/turkjped.2022.249
APA Kısaoğlu H, Baba O, KALYONCU M (2023). Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. Turkish Journal of Pediatrics, 65(1), 170 - 175. 10.24953/turkjped.2022.249
Chicago Kısaoğlu Hakan,Baba Ozge,KALYONCU MUKADDES Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. Turkish Journal of Pediatrics 65, no.1 (2023): 170 - 175. 10.24953/turkjped.2022.249
MLA Kısaoğlu Hakan,Baba Ozge,KALYONCU MUKADDES Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. Turkish Journal of Pediatrics, vol.65, no.1, 2023, ss.170 - 175. 10.24953/turkjped.2022.249
AMA Kısaoğlu H,Baba O,KALYONCU M Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. Turkish Journal of Pediatrics. 2023; 65(1): 170 - 175. 10.24953/turkjped.2022.249
Vancouver Kısaoğlu H,Baba O,KALYONCU M Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl. Turkish Journal of Pediatrics. 2023; 65(1): 170 - 175. 10.24953/turkjped.2022.249
IEEE Kısaoğlu H,Baba O,KALYONCU M "Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl." Turkish Journal of Pediatrics, 65, ss.170 - 175, 2023. 10.24953/turkjped.2022.249
ISNAD Kısaoğlu, Hakan vd. "Mercury exposure mimicking systemic lupus erythematosus in a thirteen-year-old girl". Turkish Journal of Pediatrics 65/1 (2023), 170-175. https://doi.org/10.24953/turkjped.2022.249