Personalized Prevention in Mercury-Induced Amyotrophic Lateral Sclerosis: A Case Report

Chronic exposure to low levels of mercury is involved in the development of motor\r\nneuron diseases (MND). Genetic alterations may have a crucial role in the onset and progression.\r\nWe presented a case of a TANK-binding kinase 1 (TBK1)-mutated 54-year-old male worker who\r\ndeveloped a MND due to chronic mercury exposure at work. He was employed in a chlor-alkali plant\r\nin Central Italy. After two years of employment he had acute mercury intoxication with suggestive\r\nneurological symptoms and a high urinary level of the metal. Through years, many episodes of\r\nintoxication occurred, but he continued to perform the same job and be exposed to mercury. After yet\r\nanother episode of intoxication in 2013, he showed fasciculations of the upper limbs and trunk,\r\nand electromyographic activity patterns were consistent with amyotrophic lateral sclerosis (ALS).\r\nIn 2016, a genetic test revealed a mutation of TBK1, an ALS-related gene. This case highlights the\r\nimportant role of genetics in personalized occupational medicine. Occupational physicians should\r\nuse genetic tests to identify conditions of individual susceptibility in workers with documented\r\nfrequent episodes of mercury intoxication recorded during health surveillance programs to customize\r\nprevention measures in the workplace and act before damage appears.