Exposure to certain heavy metals can result in an enterocolitis.


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.


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