関: pink disease

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/25 11:25:14」(JST)

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Acrodynia refers to a condition of pain and dusky pink discoloration in the hands and feet most often seen in children chronically exposed to heavy metals, especially mercury.

The word is derived from the Greek, where ακρος means high (as in:in an extremity) and οδυνη means pain. As such, it might be (erroneously) used to indicate that a patient has pain in the hands or feet. However, acrodynia is a disease rather than a symptom.^[1] The condition is known by a large number of other names including Pink's disease, hydrargyria, mercurialism, erythredema, erythredema polyneuropathy, Bilderbeck's, Selter's, Swift's and Swift-Feer disease.

Causes

Mercury compounds like calomel were historically used for various medical purposes: as laxatives, diuretics, antiseptics or antimicrobial drugs for syphilis, typhus and yellow fever^[2] . Teething powders were are widespread source of mercury poisoning until the recognition of mercury toxicity in the 1940s.

However, mercury poisoning and acrodynia still exist today.^[3] Modern sources of mercury intoxication include broken thermometers.^[4]

Symptoms

Besides peripheral neuropathy (presenting as paresthesia or itching, burning or pain) and discoloration, swelling (edema) and desquamation may occur.

Since mercury blocks the degradation pathway of catecholamines, epinephrine excess causes profuse sweating (diaphora), tachycardia, salivation and elevated blood pressure. Mercury is suggested to inactivate S-adenosyl-methionine, which is necessary for catecholamine catabolism by catechol-o-methyl transferase.

Affected children may show red cheeks and nose, red (erythematous) lips, loss of hair, teeth, and nails, transient rashes, hypotonia and photophobia. Other symptoms may include kidney disfunction (e.g. Fanconi syndrome) or neuropsychiatric symptoms (emotional lability, memory impairment, insomnia).

Thus, the clinical presentation may resemble pheochromocytoma or Kawasaki disease.

There is some evidence that the same mercury poisoning may predispose to Young's syndrome (men with bronchiectasis and low sperm count).^[5]

Therapy

The standard of care is discontinuation of the environmental exposure, and chelation therapy (with EDTA or maybe better, DMSA).

References

^ Horowitz Y, Greenberg D, Ling G, Lifshitz M. Acrodynia: a case report of two siblings. Arch Dis Child 2002; 86: 453. doi:10.1136/adc.86.6.453 PMID 12023189
^ Beck C, Krafchik B, Traubici J, Jacobson S. Mercury intoxication: it still exists. Pediatr Dermatol 2004; 21: 254-9. PMID 15165207
^ Weinstein M, Bernstein S. Pink ladies: mercury poisoning in twin girls. CMAJ 2003; 168: 201. PMID 12538551
^ Torres AD, Rai AN, Hardiek ML. Mercury intoxication and arterial hypertension: report of two patients and review of the literature. Pediatrics 2000; 105: E34. PMID 10699136
^ Hendry WF, A'Hern FPA, Cole PJ. Was Young's syndrome caused by mercury exposure in childhood? BMJ 1993;307:1579-82. doi:10.1136/bmj.307.6919.1579 PMID 8292944

UpToDate Contents

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1. 水銀の毒性および疫学 epidemiology and toxicity of mercury
2. 川崎病：臨床的特徴および診断 kawasaki disease clinical features and diagnosis

English Journal

Metallic mercury vapour poisoning revisited.

Mahajan VK, Sharma NL.SourceDepartment of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
The Australasian journal of dermatology.Australas J Dermatol.2011 Nov;52(4):e5-7. doi: 10.1111/j.1440-0960.2010.00679.x. Epub 2010 Aug 16.
Mercury poisoning was once common in the 19th century. With its declining use, now clinicians and the public in general are often unaware and unsuspecting of mercury toxicity. A 40-year-old woman and her two children were hospitalized with a 1-week history of a generalized lichenoid eruption. Clinic
PMID 22070717

Ancestry of pink disease (infantile acrodynia) identified as a risk factor for autism spectrum disorders.

Shandley K, Austin DW.SourceSwinburne Autism Bio-Research Initiative (SABRI), Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Hawthorn, Victoria, Australia.
Journal of toxicology and environmental health. Part A.J Toxicol Environ Health A.2011 Sep 15;74(18):1185-94.
Pink disease (infantile acrodynia) was especially prevalent in the first half of the 20th century. Primarily attributed to exposure to mercury (Hg) commonly found in teething powders, the condition was developed by approximately 1 in 500 exposed children. The differential risk factor was identified
PMID 21797771