ESPN 51th Annual Meeting

ESPN 2018


 
AN UNUSUAL CAUSE FOR RESISTANT HYPERTENSION AND DIFFUSE MUSCULOSKELETAL PAIN?
FUNDA BAŞTUĞ 1 AYŞENUR KISAARSLAN 2 HÜLYA NALÇACIOĞLU 1 SIBEL YEL 1

1- SBU KAYSERI EDUCATIONAL AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- SBU KAYSERI EDUCATIONAL AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC RHEUMATOLOGY
 
Introduction:

A previously healthy 13-year-old male patient was admitted to our pediatric rheumatology clinic with symptoms of waist and calf pain, weight loss, excessive sweating, tremor, and diffuse pain in the whole body, which began a month ago.

Physical examination was revealed hypertension (170/110 mmHg), pain all over the body and skin eruption on the legs and back of the patient and he was admitted to the hospital to investigate the etiology.

His laboratory tests revealed blood biochemical values were normal except for mild hypokalemia (3.2 mmol/L), acute phase reactants were negative, no atypical cell weren’t observed in peripheral blood smear. Urine analysis showed glucosuria (++) and slight metabolic alkalosis in blood gases (pH: 7.46, HCO3: 28). Renal tubular function tests were normal. Thyroid functions were normal, ANA (-), HLA B27 (-), Brucella (-), Vitamin B12 normal. Renal doppler US normal and urinary US bilateral renal parenchyma echogenicity increased. Long bone x-ray graphy, echocardiography and ocular examination were normal. Serum aldosterone and renin levels are normal.

What could be the diagnosis of our patient with resistant hypertension which can be controlled by triple antihypertensive therapy, mild hypokalemia, metabolic alkalosis and glucosuria, rash on the skin, widespread pain in the whole body? Malignancy? Rhematologic disease? or Infections? Although all findings of our patient seem confusing, a simple clue we learned from the patient provided us to diagnose the patient. Has the patient been exposed to mercury? Yes. Urine mercury level was high. We diagnosed chronic mercury poisoning and treated the patient.

Mercury poisoning should be kept in mind in the etiology of resistant hypertension.

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