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

Heavy metal toxicity

Evaluation

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

Management

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

Disposition


See Also


References

    • UpToDate, Tintinalli's
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