Heavy metals associated with enterocolitis:
(1) gold (usually as gold salts used in rheumatology)
(2) silver
(3) arsenic
(4) mercury
Sources of exposure:
(1) medicinal
(2) occupational
(3) accidental
(4) homicidal or suicidal
Mechanisms that may be involved:
(1) direct toxic effect on the enterocytes
(2) hypersensitivity reaction
Clinical features:
(1) abdominal pain
(2) nausea and vomiting
(3) diarrhea
(4) fever
(5) variable skin rash
Laboratory features:
(1) variable eosinophilia
(2) presence of the causative heavy metal
Findings at endoscopy may include:
(1) pseudomembranous enterocolitis
(2) mucosal ulcerations
(3) petechial hemorrhages
(4) toxic megacolon
The diagnosis is usually not considered unless the exposure history is known or other causes of enterocolitis have been excluded.
