Heavy metal toxicity is a global health concern. Mercury intoxication has been implicated in the etiology and pathogenesis of autoimmune disease, including Morvan syndrome. We describe two siblings with overlapping features of distinct autoimmune syndromes following accidental exposure to elemental mercury. Morvan syndrome was the predominant clinical phenotype. In addition to the characteristic anti-leucine-rich glioma-inactivated protein 1 (LGI1) and anti-contactin-associated protein-like 2 (Caspr2) autoantibodies, glutamic acid decarboxylase 65-kilodalton isoform (GAD65), and N-type and P/Q-type voltage-gated calcium channel (VGCC) antibodies were detected. Treatment with chelation therapy, glucocorticoids, and intravenous immunoglobulin was unsuccessful, but complete resolution of symptoms was achieved following treatment with rituximab. Herein, we perform an extensive review of the literature with a focus on the emerging concepts of mercury-induced autoimmunity and the role of mercury in the etiopathogenesis of autoimmune diseases of the nervous system.

中文翻译：

---

汞引起的自身免疫：两个患有莫文综合征“加”的青少年兄弟姐妹的报告和文献综述


重金属毒性是一个全球性的健康问题。汞中毒与自身免疫性疾病（包括莫文综合征）的病因和发病机制有关。我们描述了两个兄弟姐妹在意外接触元素汞后具有不同自身免疫综合征的重叠特征。莫文综合征是主要的临床表型。除了特征性抗富含亮氨酸的神经胶质瘤失活蛋白 1 (LGI1) 和抗接触素相关蛋白样 2 (Caspr2) 自身抗体外，谷氨酸脱羧酶 65 千道尔顿亚型 (GAD65) 以及 N 型和 P 型检测到/Q型电压门控钙通道（VGCC）抗体。螯合疗法、糖皮质激素和静脉注射免疫球蛋白的治疗不成功，但在利妥昔单抗治疗后症状完全缓解。在此，我们对文献进行了广泛的回顾，重点关注汞诱导的自身免疫的新兴概念以及汞在神经系统自身免疫性疾病发病机制中的作用。