Subcutaneous Injection Of Elemental Mercury – An Unusual Method Of Deliberate Self Harm – A Case Report

Subcutaneous Injection Of Elemental Mercury – An Unusual Method Of Deliberate Self Harm – A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Subcutaneous Injection Of Elemental Mercury – An Unusual Method Of Deliberate Self Harm – A Case Report Safuvan Mohammed, Soumya Prakash, Haritha Sunil, Nisha Cyriac, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8560150/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Deliberate self-harm by subcutaneous injection of elemental mercury using a fine-gauge insulin syringe has been rarely reported in the literature. This case highlights the role of impulsivity, non-disclosure, and emotional distress in unusual self-harm behaviours. Here we are reporting a case of a 44-year-old male with borderline intelligence, financial stressors and depressive episode, who attempted self-harm twice at a gap of one week. Initially, he broke a mercury thermometer and aspirated the mercury using an insulin syringe and injected it into his wrist, considering mercury to be lethal. After one week, he consumed multiple tablets of Quetiapine with the intention of dying. After each act, despite hospital visits, the attempts were not disclosed. Due to worsening of low mood, he was admitted in psychiatry, and he disclosed his attempts to the psychiatrist for the first time. X-rays of the wrist revealed multiple subcutaneous mercury droplets. He was managed with psychiatric treatment, and his mood improved. The physician advised monitoring, as there were no features of systemic toxicity. Elective surgical removal of the lesion was done, and the biopsy revealed mercury granuloma. This case illustrates how nondisclosure in unusual methods of self-harm can delay diagnosis and emphasises the need for empathetic evaluation. Psychology Mercury injection deliberate self-harm psychiatric emergency non-disclosure case report Figures Figure 1 Figure 2 Introduction Deliberate self-harm by injecting elemental mercury is rarely reported.(Hill, 1967; Soo et al., 2003; Wale et al., 2010) Due to the high density, extremely high surface tension, and low adhesion, mercury is difficult to aspirate through fine needles. Unless injected intravenously, systemic absorption is poor and may cause only local reactions. However, individuals who are experiencing severe psychological distress and impaired judgment may use unpredictable and dangerous methods of self-injury. Impulsivity, limited intellectual capacity, and faulty knowledge can increase the risk. Non-disclosure of self-harm attempts from healthcare providers is common among individuals with a fear of being judged or having mixed feelings about living. Non-disclosure complicates diagnosis and delays appropriate intervention. This case report highlights a rare method of self-harm, delayed disclosure, and the clinical challenges in managing emotionally distressed patients. Case Report A 44-year-old male was admitted to the psychiatry ward for pervasive low mood and death wishes. He was having financial liabilities, interpersonal relationship issues, and chronic feelings of not being good enough. Intellectual assessment suggested dull-normal intelligence, contributing to poor judgment, coping skills and problem-solving capacity. There is no history of medical comorbidity or psychiatric illness in the family. On examination, a well-defined swelling over the radial aspect of the left wrist was noted.[Figure 1] It was non-tender, without erythema or warmth. Neurological examination was normal. Mental status examination revealed low mood, hopelessness, and suicidal ideation. Timeline: 3 weeks before admission : Financial stress; an impulsive idea to self-harm after seeing a mercury thermometer Same day : Broke thermometer → aspirated mercury with insulin syringe → injected into the left wrist One day later : Developed swelling in wrist; consulted at local hospital but reported false history (hammer injury) 2 weeks before admission : Ingested multiple tablets of Quetiapine → dizziness; consulted at local hospital but didn’t disclose ingestion of tablets Current admission : Worsening depression → admitted to psychiatry → disclosed both attempts for the first time During admission : X-ray confirmed mercury deposits; psychiatric + medical management initiated Follow-up after 1 week : Mood improved; good drug adherence; willing for elective surgical excision Follow-up after 1 month : Euthymic; good drug adherence; surgical excision done. Investigations: X-ray: Multiple discrete radiopaque droplets in the subcutaneous plane characteristic of elemental mercury. [Figure 2] Laboratory tests: CBC, RFT, LFT normal. Chest X-ray: Normal. No signs of systemic mercury toxicity. Biopsy report: Excision biopsy of mercury granuloma - left wrist revealed cutaneous mercury granuloma. Diagnostic Challenges: Non-disclosure of self-harm attempts during the two previous consultations Unusual method of self-harm attempt Differential Diagnoses of the wrist swelling considered: Post-traumatic hematoma Soft-tissue calcification Final Diagnosis: Subcutaneous mercury injection leading to localised mercury granuloma Major depressive episode, severe, without psychotic symptoms Deliberate Self-Harm attempts with non-disclosure Management: A general medicine consultation was done, and the patient was advised to undergo serial renal monitoring. A plastic surgery consultation was done, and an elective excision of the subcutaneous mercury deposits was done to prevent long-term complications. Chelation therapy was not indicated due to the absence of systemic toxicity. A comprehensive suicide risk assessment showed high risk due to the two recent consecutive self-harm attempts, use of a rare and potentially harmful method, repeated non-disclosure of self-harm attempts during medical visits, financial stressors, depressive episode and borderline intelligence with poor coping skills. He was provided with supportive psychotherapy, and pharmacotherapy was optimised with Escitalopram 10 mg and Quetiapine 25 mg. The psychotherapy sessions focused on emotional regulation, developing coping skills, and identifying triggers. His spouse was counselled on supervision, communication, and early warning signs. Since the injected mercury formed a localised granuloma, the chance of systemic toxicity is low. Also, excision of the mercury granuloma was done, and routine monitoring is planned. He showed early improvement with pharmacotherapy and psychotherapy. So, despite borderline intellectual functioning, if medication adherence, continued psychoeducation, and regular follow-up evaluations are ensured, he can be considered to have a favourable prognosis. During the course of hospitalisation, improvement was noted, and further suicidal ideation was not elicited. During the first outpatient visit after discharge from the hospital, he had no features of systemic toxicity and was willing to undergo surgical excision of the lesion. One month after discharge, he is euthymic, and he understands the need for seeking timely help and expressed relief for having disclosed self-harm attempts. Discussion Injection of elemental mercury is an unusual and difficult method of self-harm. The physical characteristics of elemental mercury make aspiration through fine-gauge needles difficult. In this case, the impulsive determination of the patient resulted in successfully injecting it subcutaneously. Subcutaneous mercury typically remains localised, which explains the absence of systemic toxicity in this case. This patient's presentation has several important lessons: Impulsivity The act was triggered by encountering a discarded thermometer—a moment of opportunity triggered the thought that mercury can cause painless death. Non-disclosure His reluctance to disclose the acts during medical encounters was due to the fear of being judged and the ambivalence towards living. Such non-disclosure strongly increases suicide risk. Worsening Under Severe Stress The trial from a rare toxicological method to a psychotropic overdose within days shows his emotional dysregulation and worsening psychological distress. Importance of Empathetic Evaluation It was only during the psychiatric interview that he felt safe enough to reveal the truth, resulting in appropriate investigations and treatment. Early detection, empathetic engagement, and multidisciplinary intervention are essential in ensuring safety during psychiatric emergencies. Strengths: Unusual method of self harm, confirmed by radiographic image. The case also highlights the complex interplay of impulsivity, psychological distress, poor coping skills, reduced intellectual capacity and nondisclosure in self-harm behaviours. Limitation: Follow-up duration is limited. Conclusion Subcutaneous injection of elemental mercury is a rarely reported method of self-harm. This case shows the importance of maintaining a high degree of suspicion when patients present with inconsistent histories. Radiographs provide decisive diagnostic evidence. Empathetic psychiatric assessment and timely intervention are crucial in preventing recurrence. Declarations Patient Perspective The patient is currently euthymic. He is aware of the possible consequences of mercury retained in the body. He underwent surgical excision of the mercury granuloma. He also reported feeling supported during the psychiatric admission. He recognises the importance of seeking timely help. Declaration of Patient Consent The authors obtained consent from patient. The patient agreed to the publication of clinical information and images, with the understanding that anonymity would be maintained as far as possible. Financial Support and Sponsorship Nil. Conflicts of Interest None declared. References Hill, D. M. (1967). Self-administration of mercury by subcutaneous injection. British Medical Journal , 1 (5536), 342–343. https://doi.org/10.1136/bmj.1.5536.342 Soo, Y. O., Wong, C. H., Griffith, J. F., & Chan, T. Y. (2003). Subcutaneous injection of metallic mercury. Human & Experimental Toxicology , 22 (6), 345–348. https://doi.org/10.1191/0960327103ht345cr Wale, J., Yadav, P. K., & Garg, S. (2010). Elemental mercury poisoning caused by subcutaneous and intravenous injection: An unusual self-injury. The Indian Journal of Radiology & Imaging , 20 (2), 147–149. https://doi.org/10.4103/0971-3026.63056 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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2","display":"","copyAsset":false,"role":"figure","size":91021,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2 : Xray Wrist AP and Lateral view\u003c/p\u003e","description":"","filename":"xray.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8560150/v1/d6fa59f486698bc0b070c935.jpg"},{"id":100382550,"identity":"21a5542f-3411-4f4d-a85d-3a5b3ea5f6c4","added_by":"auto","created_at":"2026-01-16 10:43:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824651,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8560150/v1/3fa4b57e-43e6-46b1-adcc-916dfbc94e7c.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSubcutaneous Injection Of Elemental Mercury – An Unusual Method Of Deliberate Self Harm – A Case Report\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDeliberate self-harm by injecting elemental mercury is rarely reported.(Hill, 1967; Soo et al., 2003; Wale et al., 2010) Due to the high density, extremely high surface tension, and low adhesion, mercury is difficult to aspirate through fine needles. Unless injected intravenously, systemic absorption is poor and may cause only local reactions. However, individuals who are experiencing severe psychological distress and impaired judgment may use unpredictable and dangerous methods of self-injury.\u003c/p\u003e\n\u003cp\u003eImpulsivity, limited intellectual capacity, and faulty knowledge can increase the risk. Non-disclosure of self-harm attempts from healthcare providers is common among individuals with a fear of being judged or having mixed feelings about living. Non-disclosure complicates diagnosis and delays appropriate intervention.\u003c/p\u003e\n\u003cp\u003eThis case report highlights a rare method of self-harm, delayed disclosure, and the clinical challenges in managing emotionally distressed patients.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 44-year-old male was admitted to the psychiatry ward for pervasive low mood and death wishes. He was having financial liabilities, interpersonal relationship issues, and chronic feelings of not being good enough. Intellectual assessment suggested dull-normal intelligence, contributing to poor judgment, coping skills and problem-solving capacity. There is no history of medical comorbidity or psychiatric illness in the family.\u003c/p\u003e\n\u003cp\u003eOn examination, a well-defined swelling over the radial aspect of the left wrist was noted.[Figure 1] \u0026nbsp;It was non-tender, without erythema or warmth. Neurological examination was normal. Mental status examination revealed low mood, hopelessness, and suicidal ideation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTimeline:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e3 weeks before admission\u003c/u\u003e: Financial stress; an impulsive idea to self-harm after seeing a mercury thermometer\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eSame day\u003c/u\u003e: Broke thermometer → aspirated mercury with insulin syringe → injected into the left wrist\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOne day later\u003c/u\u003e: Developed swelling in wrist; consulted at local hospital but reported false history (hammer injury)\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e2 weeks before admission\u003c/u\u003e: Ingested multiple tablets of Quetiapine → dizziness; consulted at local hospital but didn’t disclose ingestion of tablets\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCurrent admission\u003c/u\u003e: Worsening depression → admitted to psychiatry → disclosed both attempts for the first time\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDuring admission\u003c/u\u003e: X-ray confirmed mercury deposits; psychiatric + medical management initiated\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFollow-up after 1 week\u003c/u\u003e: Mood improved; good drug adherence; willing for elective surgical excision\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFollow-up after 1 month\u003c/u\u003e: \u0026nbsp;Euthymic; good drug adherence; surgical excision done.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eX-ray: Multiple discrete radiopaque droplets in the subcutaneous plane characteristic of elemental mercury. [Figure 2]\u003c/p\u003e\n\u003cp\u003eLaboratory tests: CBC, RFT, LFT normal.\u003c/p\u003e\n\u003cp\u003eChest X-ray: Normal.\u003c/p\u003e\n\u003cp\u003eNo signs of systemic mercury toxicity.\u003c/p\u003e\n\u003cp\u003eBiopsy report: Excision biopsy of mercury granuloma - left wrist revealed cutaneous mercury granuloma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Challenges:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNon-disclosure of self-harm attempts during the two previous consultations\u003c/p\u003e\n\u003cp\u003eUnusual method of self-harm attempt\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferential Diagnoses of the wrist swelling considered:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost-traumatic hematoma\u003c/p\u003e\n\u003cp\u003eSoft-tissue calcification\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinal Diagnosis:\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eSubcutaneous mercury injection leading to localised mercury granuloma\u003c/li\u003e\n \u003cli\u003eMajor depressive episode, severe, without psychotic symptoms\u003c/li\u003e\n \u003cli\u003eDeliberate Self-Harm attempts with non-disclosure\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eManagement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA general medicine consultation was done, and the patient was advised to undergo serial renal monitoring. A plastic surgery consultation was done, and an elective excision of the subcutaneous mercury deposits was done to prevent long-term complications. Chelation therapy was not indicated due to the absence of systemic toxicity.\u003c/p\u003e\n\u003cp\u003eA comprehensive suicide risk assessment showed high risk due to the two recent consecutive self-harm attempts, use of a rare and potentially harmful method, repeated non-disclosure of self-harm attempts during medical visits, financial stressors, depressive episode and borderline intelligence with poor coping skills.\u003c/p\u003e\n\u003cp\u003eHe was provided with supportive psychotherapy, and pharmacotherapy was optimised with Escitalopram 10 mg and Quetiapine 25 mg. The psychotherapy sessions focused on emotional regulation, developing coping skills, and identifying triggers. His spouse was counselled on supervision, communication, and early warning signs.\u003c/p\u003e\n\u003cp\u003eSince the injected mercury formed a localised granuloma, the chance of systemic toxicity is low. Also, excision of the mercury granuloma was done, and routine monitoring is planned. He showed early improvement with pharmacotherapy and psychotherapy. So, despite borderline intellectual functioning, if medication adherence, continued psychoeducation, and regular follow-up evaluations are ensured, he can be considered to have a favourable prognosis.\u003c/p\u003e\n\u003cp\u003eDuring the course of hospitalisation, improvement was noted, and further suicidal ideation was not elicited. During the first outpatient visit after discharge from the hospital, he had no features of systemic toxicity and was willing to undergo surgical excision of the lesion. One month after discharge, he is euthymic, and he understands the need for seeking timely help and expressed relief for having disclosed self-harm attempts.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eInjection of elemental mercury is an unusual and difficult method of self-harm. The physical characteristics of elemental mercury make aspiration through fine-gauge needles difficult. In this case, the impulsive determination of the patient resulted in successfully injecting it subcutaneously. Subcutaneous mercury typically remains localised, which explains the absence of systemic toxicity in this case.\u003c/p\u003e\n\u003cp\u003eThis patient's presentation has several important lessons:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eImpulsivity\u003cbr\u003e\u0026nbsp;The act was triggered by encountering a discarded thermometer—a moment of opportunity triggered the thought that mercury can cause painless death.\u003c/li\u003e\n \u003cli\u003eNon-disclosure\u003cbr\u003e\u0026nbsp;His reluctance to disclose the acts during medical encounters was due to the fear of being judged and the ambivalence towards living. Such non-disclosure strongly increases suicide risk.\u003c/li\u003e\n \u003cli\u003eWorsening Under Severe Stress\u003cbr\u003e\u0026nbsp;The trial from a rare toxicological method to a psychotropic overdose within days shows his emotional dysregulation and worsening psychological distress.\u003c/li\u003e\n \u003cli\u003eImportance of Empathetic Evaluation\u003cbr\u003e\u0026nbsp;It was only during the psychiatric interview that he felt safe enough to reveal the truth, resulting in appropriate investigations and treatment.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEarly detection, empathetic engagement, and multidisciplinary intervention are essential in ensuring safety during psychiatric emergencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths:\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eUnusual method of self harm, confirmed by radiographic image.\u003c/li\u003e\n \u003cli\u003eThe case also highlights the complex interplay of impulsivity, psychological distress, poor coping skills, reduced intellectual capacity and nondisclosure in self-harm behaviours.\u003c/li\u003e\n\u003c/ol\u003e\u003cp\u003e\u003cstrong\u003eLimitation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollow-up duration is limited.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSubcutaneous injection of elemental mercury is a rarely reported method of self-harm. This case shows the importance of maintaining a high degree of suspicion when patients present with inconsistent histories. Radiographs provide decisive diagnostic evidence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Empathetic psychiatric assessment and timely intervention are crucial in preventing recurrence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ePatient Perspective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient is currently euthymic. He is aware of the possible consequences of mercury retained in the body. He underwent surgical excision of the mercury granuloma. He also reported feeling supported during the psychiatric admission. He recognises the importance of seeking timely help.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Patient Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors obtained consent from patient. The patient agreed to the publication of clinical information and images, with the understanding that anonymity would be maintained as far as possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Support and Sponsorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNil.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHill, D. M. (1967). Self-administration of mercury by subcutaneous injection. \u003cem\u003eBritish Medical Journal\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(5536), 342\u0026ndash;343. https://doi.org/10.1136/bmj.1.5536.342\u003c/li\u003e\n \u003cli\u003eSoo, Y. O., Wong, C. H., Griffith, J. F., \u0026amp; Chan, T. Y. (2003). Subcutaneous injection of metallic mercury. \u003cem\u003eHuman \u0026amp; Experimental Toxicology\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(6), 345\u0026ndash;348. https://doi.org/10.1191/0960327103ht345cr\u003c/li\u003e\n \u003cli\u003eWale, J., Yadav, P. K., \u0026amp; Garg, S. (2010). Elemental mercury poisoning caused by subcutaneous and intravenous injection: An unusual self-injury. \u003cem\u003eThe Indian Journal of Radiology \u0026amp; Imaging\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(2), 147\u0026ndash;149. https://doi.org/10.4103/0971-3026.63056\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Government Medical College Kottayam","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mercury injection, deliberate self-harm, psychiatric emergency, non-disclosure, case report","lastPublishedDoi":"10.21203/rs.3.rs-8560150/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8560150/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDeliberate self-harm by subcutaneous injection of elemental mercury using a fine-gauge insulin syringe has been rarely reported in the literature. This case highlights the role of impulsivity, non-disclosure, and emotional distress in unusual self-harm behaviours.\u003c/p\u003e\n\u003cp\u003eHere we are reporting a case of a 44-year-old male with borderline intelligence, financial stressors and depressive episode, who attempted self-harm twice at a gap of one week.\u003c/p\u003e\n\u003cp\u003eInitially, he broke a mercury thermometer and aspirated the mercury using an insulin syringe and injected it into his wrist, considering mercury to be lethal. After one week, he consumed multiple tablets of Quetiapine with the intention of dying. After each act, despite hospital visits, the attempts were not disclosed.\u003c/p\u003e\n\u003cp\u003eDue to worsening of low mood, he was admitted in psychiatry, and he disclosed his attempts to the psychiatrist for the first time. X-rays of the wrist revealed multiple subcutaneous mercury droplets. He was managed with psychiatric treatment, and his mood improved. The physician advised monitoring, as there were no features of systemic toxicity. Elective surgical removal of the lesion was done, and the biopsy revealed mercury granuloma.\u003c/p\u003e\n\u003cp\u003eThis case illustrates how nondisclosure in unusual methods of self-harm can delay diagnosis and emphasises the need for empathetic evaluation.\u003c/p\u003e","manuscriptTitle":"Subcutaneous Injection Of Elemental Mercury – An Unusual Method Of Deliberate Self Harm – A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 15:12:46","doi":"10.21203/rs.3.rs-8560150/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"78bafa36-9c0e-4645-9f02-f793436097e7","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":60872504,"name":"Psychology"}],"tags":[],"updatedAt":"2026-01-13T15:12:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 15:12:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8560150","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8560150","identity":"rs-8560150","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}