Feer’s disease or acrodynia is mercury poisoning that manifests in dermatologic, motor, and psycho-vegetative symptoms. Untreated acrodynia can end in fatal sepsis. Reliable antidotes are now available as treatment options.
What is acrodynia?
Feer’s disease or acrodynia is mercury poisoning that manifests in dermatologic, motor, and psycho-vegetative symptoms. Acryodynia is also known as Feer’ disease or Feer’s disease. It was first described by the Zurich pediatrician Emil F. Feer. Sometimes the disease is also referred to as pink disease or toxallergic brainstem encephalitis. These names aptly describe the phenomenon in terms of its causes and leading symptoms. Accordingly, acrodynia is the after-effect of a poisoning symptom and affects both the skin and the brain. There is brainstem encephaly with permanent brain damage. The skin is affected by eczema and develops reddish discolorations. Overall, a number of motor and nonspecific accompanying symptoms occur in addition to psycho-vegetative and dermatological symptoms. Acrodynias now occur only rarely. In the last millennium they occurred more frequently and at that time affected children in particular. Therefore, in the context of Feer’s disease, it was often referred to as infantile acrodynia.
Causes
Usually, acrodynia is preceded by mercury poisoning. Specifically, the organism reacts to chronic mercury poisoning with toxic-allergic reactions. The source of mercury poisoning can be various objects, medicines and ointments. In addition to mercury-containing thermometers, energy-saving lamps and batteries, amalgam dental fillings, for example, can cause the poisoning. In the meantime, however, the use of mercury is limited to the scientific field because of its toxicity. Therefore, there are not as many sources of poisoning nowadays as in the past. This has made the occurrence of acrodynia rather rare. Symptoms similar to those of mercury poisoning may also be seen in the context of other heavy metal poisonings. Arsenic, gold, chromium, and copper, in increased concentrations, thus cause toxic-allergic phenomena in the same way, although they are partially needed by the organism in low concentrations.
Symptoms, complaints and signs
The leading symptom of acrodynia is brainstem encephaly. In this manifestation, the myelin of the brain stem is degenerated. The sympathetic and parasympathetic nervous system takes damage in this process. As a consequence, psychic vegetative symptoms such as irritability, lack of appetite, depression and sleep disorders appear. Also photophobia, sweating and high blood pressure as well as fast heartbeat are symptomatic. Freezing, tremor, fever and cramps, but also sensory disturbances in the area of the feet and hands occur just as often. In most cases, the skin also becomes scaly. In the palms of the hands and on the soles of the feet, it often turns reddish. These dermatological symptoms are usually accompanied by itching, swelling and eczema. The muscles of affected individuals often show decreased tension, which sometimes progresses to movement disorders or even paralysis. Nonspecific accompanying symptoms such as tooth loss, hair loss, and gingivitis may also occur.
Diagnosis and course
In acrodynia, the physician’s primary differential diagnosis is to exclude meningitis and vitamin B deficiency. Because acrodynia results from mercury poisoning, a test for mercury is performed in the patient’s serum, urine, or saliva. Elevated mercury levels ensure a diagnosis of Feer’s disease. If a urine test is preferred, it is also referred to as a DMPS test. Here, mercury levels are determined once before and once after oral administration of dimercapto-1-propanesulfonic acid. A favorable prognosis is now considered for recognized acrodynia. However, undetected acrodynia is fatal in about five percent of cases. Most often, death occurs as a result of sleep deprivation or in the setting of pneumonia. Septic deaths can also occur for untreated acrodynia.
Complications
If acrodynia is not treated in a timely manner, it can lead to death.Mercury poisoning is a very dangerous condition for the human body and should always be treated by a doctor. As a rule, various complications occur with acrodynia. These include depression and sleep disturbances, which can also lead to an aggressive attitude. Patients complain of loss of appetite and high blood pressure. In addition, panic attacks, sweating and fever occur. The quality of life is greatly reduced by acrodynia. On the body, there are usually swellings and reddened areas, which are also associated with itching. In severe acrodynia, there may be problems with the teeth or hair. These fall out in some cases. Acrodynia can be treated relatively well, but the treatment must be done quickly. The longer the patient waits to see a doctor, the more severe the secondary damage will be. In most cases, the symptoms disappear after a few days and there are no further complaints. After the complete toxin has been removed from the body, all symptoms recede.
When should you go to the doctor?
Acrodynia must be examined and treated by a doctor in any case. If there is an acute emergency, an ambulance should definitely be called or the hospital should be visited directly. If left untreated, acrodynia can lead to the death of the patient in the worst case. The affected person suffers from various symptoms. As a rule, there is fever and cramps. Sensory disturbances and depression can also occur, and most patients also suffer from sleep disturbances. If these complaints arise suddenly, a doctor must be consulted. As the disease progresses, paralysis occurs in various regions of the body and teeth or hair may fall out. Urgent treatment is necessary for these acute symptoms. Itching or scaly skin may also indicate acrodynia. Treatment can be given either by the family doctor or directly in the hospital. As a rule, the underlying disease or cause of acrodynia must also be treated and ruled out in any case.
Treatment and therapy
Acrodynia is readily treatable today. Various methods are available for this purpose. In addition to the administration of British anti-Lewisite, treatment with penicillamine is one of the most important therapeutic options. British anti-Lewisit is abbreviated as BAL and is sometimes also called dimercaptopropanol or dithioglycerol. This is an antidote to poisoning. Antidotes are antidotes against various toxins and drugs. Therapeutic effect is shown by the administration of BAL in poisoning with various metals. Therefore, in addition to mercury poisoning, poisoning with gold, cadmium, chromium, bismuth or copper, for example, is also treated via BAL. This form of treatment was first used in connection with arsenic. At that time, arsenic poisoning in particular was treated in the context of the combat agent lewisite. Like BAL, penicillamine is a drug against various heavy metal poisonings. However, penicillamine is not a true antidote, but an alpha-amino acid that merely stimulates excretion. The amino acid binds with heavy metals and thus forms formations that are difficult to dissolve. Bound, the toxic substances can be excreted more easily through the kidneys. Depending on the symptoms of acrodynia, symptomatic therapies may need to be used in addition to causative therapies. Ataxias may be relieved, for example, via physical and occupational therapies.
Outlook and prognosis
Acrodynia can cause a variety of symptoms and complaints. Without treatment and if the amount of mercury is high, this can also lead to the death of the patient. In most cases, especially the nervous system takes damage from the poisoning. Paralysis and other sensory disturbances occur. The heartbeat increases and this can lead to heart problems or a heart attack. Partly the patients suffer from sleep disturbances, depression and sweating. Everyday life is made more difficult by a general irritability and by fever, and the quality of life is drastically reduced. Furthermore, itching and swelling develop all over the body. The affected person may also suffer from hair loss and tooth loss, and these complaints lead to an impeded food intake. Often there is also a lack of appetite, which leads to malnutrition.Without treatment of acrodynia, the patient usually dies. The treatment takes place with the help of medication and can alleviate the symptoms. Furthermore, it is essential to stop the absorption of the mercury. If the treatment is initiated early, there is no reduction in life expectancy in most cases.
Prevention
To prevent acrodynia, children in particular should be strictly protected from preparations and products containing mercury. However, since the toxicity of mercury is now known, the substance is no longer used outside the scientific field anyway. This has now somewhat alleviated the need for preventive measures. However, caution is still required in contact with older products, ointments or medicines.
Aftercare
With acrodynia, there are usually no special aftercare options available to the affected person. The patient is primarily dependent on medical treatment. If this is not initiated in a timely manner, the worst-case scenario may result in blood poisoning and thus death of the affected person. Acrodynia is usually treated with the help of medication. The affected person must always ensure that the medication is taken regularly in order to avoid further complaints. Parents should also make sure that their children always take the medication correctly. Possible interactions with other medications must also be taken into account. Furthermore, in the case of acrodynia, the affected person should naturally avoid the source of the poisoning and warn other people about it. In severe cases, surgical interventions are also necessary. After such an operation, the affected person should always rest, taking care of his body as much as possible. Strenuous activities or movements should also be avoided. In some cases, physiotherapy measures are also necessary to completely alleviate the symptoms of acrodynia. In this case, the affected person can also perform many of the exercises in his own home.
What you can do yourself
Acrodynia (Feer’s disease) is a severe form of mercury poisoning and can be fatal without professional treatment, especially in children, seniors and people whose health is already damaged. Therefore, affected persons should not hesitate to consult a doctor or hospital immediately if mercury poisoning is suspected. Under no circumstances should self-treatment be attempted. Unlike the basic disease itself, however, some of the accompanying symptoms can certainly be alleviated with simple remedies. Dermatological symptoms such as eczema, itching and swelling are particularly common. Oozing and itching skin rash often improves after use of medicinal zinc ointment from the [[]]pharmacy or drugstore. The ointment is applied thickly to the affected areas and covered with a plaster or bandage. On the face and neck, the covering can be omitted. For skin lesions that are particularly itchy, antihistamines in cream, tablet or drop form, which are available over-the-counter at pharmacies, also help. Patients who cannot control the itching should wear cotton gloves, which at least prevents the already attacked skin from being contaminated and injured by the fingernails, thus adding secondary inflammations. The also frequently occurring tooth and gum problems should be discussed with a dentist. Increased oral hygiene is helpful, especially in the case of gingivitis.
