Heavy-metal therapy has been used for many years in the treatment of syphilis, lupus erythematosus, lichen planus, verrucae, and other diseases. Today when a heavy metal is indicated, because of its relatively low toxicity, bismuth has almost completely replaced mercury.
Hudelo and Rabut* early described the side-reactions of bismuth therapy. They discussed bismuth line, bismuth stomatitis and gingivitis, gastrointestinal reactions, jaundice, dermatoses of various kinds, renal disorders, neurological and psychological reactions. They also included joint and muscular pains, particularly in the lumbar, knee, leg, thigh, scapulohumeral, shoulder, arm, and forearm regions. These pains were exacerbated with each injection and disappeared rapidly after cessation of treatment. Such manifestations of arthralgia and myalgia were found to be related to "bismuth grippe" or "bismuth asthenia," which is characterized by fever, chills, sweats, headaches, malaise, general weakness, lassitude, anorexia, vomiting, and diarrhea, together with myalgia and arthralgia; these were said to follow bismuth
ZELIGMAN I. BISMUTH ARTHRALGIA. AMA Arch Derm Syphilol. 1955;71(1):108–111. doi:10.1001/archderm.1955.01540250110019
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