Acrodyny T56.11

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 09.07.2024

Synonym(s)

Acrodynia; Feer's disease; neurosis vegetative of infants; pink disease; Pink Disease; rare swift-feers disease; Swift Syndrome; vegetative neurosis of infants

History
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E.Feer 1923

Definition
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Today rare, probably caused by mercury intoxication, brain stem encephalopathy with skin and multiple organ symptoms in small children.

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Manifestation
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25 months to 7 years of age.

Clinical features
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Initial changes in character: tearfulness, increasing apathy, possibly trichotillomania. After 2-4 weeks cold, moist, cyanotic, swollen hands and feet with coarse lamellar palmoplantar desquamation. Possibly generalized, itchy erythema. Severe hyperhidrosis up to miliaria rubra. In severe cases diffuse alopecia, loss of nails and teeth. Internal symptoms: tachycardia, arterial hypertension, marked fluctuations in blood sugar levels, generalized muscle weakness, sleep disturbances, weight loss. Photophobia, conjunctivitis. Possibly painful paresthesias. The children constantly rub their hands and feet, automutilation occurs.

Laboratory
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mercury in both senses of the word.

Differential diagnosis
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Erythema scarlatiniforme desquamativum recidivans.

Therapy
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Avoid mercury. For acute inorganic mercury intoxication: Dimercaprol (DMPS, e.g. Dimaval). Drinking egg milk, emetic, gastric lavage, plasma expander, haemodialysis, antibiotics. For chronic intoxication with organic mercury: N-acetylcysteine. If necessary, several weeks trial with DMPS. Experimental vitamin B administration. Specific chelating agents ( D-penicillamine) to promote mercury excretion, see below. antidote.

Literature
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Boyd AS et al (2000) Mercury exposure and cutaneous disease. J Am Acad Dermatol 43(1 Pt 1): 81-90
Dinehart MD et al. (1988) Cutaneous manifestation of acrodynia (pink disease). Arch Dermatol 124: 107-109
Feer E (1923) On a peculiar neurosis of the vegetative system in infants. Erg.d inn Med u Kinderheilk 24
Havarinasab S et al. (2004) Dose-response study of thimerosal-induced murine systemic autoimmunity. Toxicol Appl Pharmacol 194: 169-179
Horowitz Y et al (2002) Acrodynia: a case report of two siblings. Arch Dis Child 86: 453
Rütter A et al (1996) Metal dermatoses II. Dermatology 47: 400-409
Shekhawat R et al (2022) Acrodynia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 32644540.