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
- 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
Heavy metal toxicity
- Aluminum toxicity
- Antimony toxicity
- Arsenic toxicity
- Barium toxicity
- Bismuth toxicity
- Cadmium 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
- Zinc toxicity
Evaluation
- CBC, BMP, LFTs, UA
- Assess for alternative diagnoses
Management
- Supportive care
- Most symptoms improve with cessation of gold therapy
Disposition
See Also
External Links
References
- UpToDate, Tintinalli's