Gold toxicity

Background

• Gold is sometimes administered (as gold sodium thiomalate or Auranofin) IM/IV to treat rheumatoid arthritis and other autoimmune diseases
• Use limited by significant adverse effect profile, including toxicity, and need for close monitoring

Clinical Features

• Mucocutaneous effects- most common
  • Dermatitis, pruritus, urticaria, stomatitis
  • Less common: alopecia, trophic nails, pseudocyanosis (non-blanching blue-grey skin discoloration; spares mucous membranes, may be more pronounced where sun-exposed)
• Metallic taste
• Diarrhea, enterocolitis (mild symptoms common, sometimes severe)
• Proteinuria/membranous glomerulonephritis (common), nephrotic syndrome (rare)
• Post-injection vasomotor reaction +/- anaphylaxis, syncope (rare)
• Eosinophilia (common)
• Cytopenias, aplastic anemia (rare)
• Hepatotoxicity, pancreatitis (rare)
• Encephalopathy, peripheral/cranial neuropathies (rare)
• Interstitial pneumonitis (rare)

Differential Diagnosis

• Aluminum toxicity
• Antimony toxicity
• Arsenic toxicity
• Barium toxicity
• Beryllium toxicity
• Bismuth toxicity
• Boron toxicity
• Cadmium toxicity
• Cesium toxicity
• Chromium toxicity
• Cobalt toxicity
• Copper toxicity
• Gold toxicity
• Iron toxicity
• Lead toxicity
• Lithium toxicity
• Manganese toxicity
• Mercury toxicity
• Nickel toxicity
• Phosphorus toxicity
• Platinum toxicity
• Selenium toxicity
• Silver toxicity
• Thallium toxicity
• Tin toxicity
• Vanadium toxicity
• Zinc toxicity

Evaluation

• CBC, BMP, LFTs, UA
• Assess for alternative diagnoses

Management

• Supportive care
• Most symptoms improve with cessation of gold therapy

See Also

• Toxicology (main)
• Heavy metal toxicity

References

• UpToDate, Tintinalli's