• Khoa Nguyen-Dang, Anh-Thu Dau-Nguyen, Nguyen Tran-Ngoc, Ngoc Duong-Minh, Thong Dang-Vu, Sang Nguyen-Ngoc, Nam Vu-Hoai, and Hung Le-Quoc.
• Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam.
• Medicine (Baltimore). 2024 Dec 13; 103 (50): e41013e41013.

RationaleAmong 3 forms of mercury, elemental mercury vapor presents the highest threat due to its potential to cause acute pneumonitis. The management of acute mercury vapor poisoning remains unclear, particularly in acute lung injury. We present a case of mercury vapor poisoning resulting from the heating of cinnabar, successfully treated with high-dose corticosteroids and chelation therapy, and follow-up over 6 months.Patient ConcernsA 47-year-old female patient was admitted to the Emergency Department due to dyspnea, chest tightness, and weakness following cinnabar heating.DiagnosesUpon admission, she presented with tachypnea and respiratory failure. During the first 5 days, the respiratory failure rapidly progressed, requiring high-flow nasal cannula support, and showed no improvement with broad-spectrum intravenous (IV) antibiotics and 80 mg daily IV methylprednisolone. Total blood and urinary mercury levels were measured to confirm the diagnosis.InterventionsUpon confirmation of acute pneumonitis due to mercury vapor poisoning, the patient was administered high-dose methylprednisolone (500 mg IV per day) and chelation therapy, which led to subsequent improvement.OutcomesSix months after discharge, the patient completely recovered, as evidenced by chest imaging and pulmonary function tests.LessonsHeating elemental mercury can cause pneumonitis, leading to acute respiratory failure. A detailed history is crucial for diagnosis. High-dose methylprednisolone should be considered in patients who do not respond to lower doses. Patients should be monitored afterward to detect residual pulmonary fibrotic changes.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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