A Physical Therapist’s Perspective on Mercury Toxicity in the Acute Care Setting

Background and Purpose: Skin lightening compounds are used globally to achieve lighter skin tones to signify a culturally desirable status. These compounds can contain mercury in an inorganic form. Using skin lightening creams, especially unregulated homemade creams, may lead to dermal effects and complications such as nephrotoxicity and neurotoxicity. Prolonged mercury exposure eventually leads to cell death, including neurons and glial cells. Case Description: A 21-year-old patient presented to a tertiary medical center with acute onset of vision changes, dysarthria, sensory deficits, and memory loss. The symptoms initially lacked an identifiable cause, and Functional Neurologic Disorder was the leading differential diagnosis. Further evaluation revealed elevated mercury levels from skin lightening cream leading to the diagnosis of mercury toxicity. Outcomes: Upon interdisciplinary communication, additional testing was completed, and the correct diagnosis was identified. Early in hospitalization, the patient required minimal assist during ambulation; however, after a lengthy hospitalization with worsening symptoms, the patient was discharged at a dependent functional level. Discussion and Conclusion: Despite the patient’s unfavorable outcome, collaborative interprofessional communication during the acute care hospitalization was essential for preventing further disability or mortality. Recognition of atypical symptoms by the acute care physical therapist and allied health team were significant in pursuing an alternate diagnosis, leading to a notable change in the treatment plan. Without this effective communication, it is possible that the correct diagnosis would not have been made. It is crucial to continually assess and use critical thinking skills in acute care physical therapy to provide the highest level of care.