HYPERMANGANESEMIA, HEREDITARY HEMORRHAGIC TELANGIECTASIA, BRAIN ABSCESS: THE HEPATIC CONNECTION

To the Editor:

Kumar et al.¹ report an interesting case of hypermanganesemia, hereditary hemorrhagic telangiectasia, and brain abscess. The analytical technique for determining manganese (Mn) in serum was not reported.

Mn is usually quantified in whole blood, which may be a better biomarker than Mn in plasma or serum because approximately 94% of the metal is contained in erythrocytes.² The authors assert that “chelation therapy likely has no role” but we would challenge this statement because chelators are the first indication drugs in metal poisoning. They have been successfully used in the treatment of chronic occupational, pediatric subacute accidental, and even chronic genetic manganism with liver cirrhosis.

Calcium disodium ethylenediaminetetraacetic acid (CaNa₂EDTA), a chelator mostly used for treating saturnism, has also been useful in treating manganism. CaNa₂EDTA has been shown to protect experimental animals from lethal doses of manganese chloride and to lower brain Mn levels in poisoned rodents. Also, CaNa₂EDTA was unethically used to “prevent” occupational manganism and, through Peñalver’s pioneering work, to treat human manganism.³ The published manganism cases treated by chelation are few and toxicologic, neuroradiologic, and …