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A case of argyria secondary to the prolonged use of nasal drops that contained mild silver protein is presented. The patient was thought to be cyanosed immediately after a total knee replacement. Argyria, its differentiation from cyanosis and its prevention are discussed. The need for a careful drug history is noted.
BACKGROUND: Argyria is often considered an entity of the past, one which has largely disappeared with the cessation of silver usage in oral medications. However, with the practice of colloidal silver ingestion in current "alternative health" treatments, argyria should be considered in the differential diagnosis of blue-gray hyperpigmentation. METHODS: A single case report with clinicopathological correlation. RESULTS: Histological examination of skin biopsy specimen, which showed perieccrine brown-black granules, verified that colloidal silver rather than a prescribed medication was the source of the patient's dyspigmentation.
Scanning electron microscopes, which have energy dispersive spectroscopy (x-ray microanalysis) capability, can provide accurate identification of the composition of inorganic deposits in tissue. We report a case of florid argyria in which the same deparaffinized 4-micron sections were sequentially examined by light microscopy, scanning electron microscopy, backscattered electron imaging, and x-ray microanalysis to confirm the clinical impression of argyria. We recommend the use of x-ray microanalysis of paraffin-embedded tissue as a simple, rapid and inexpensive means of precise identification of inorganic deposits of heavy elements in tissue sections.
A 79-year-old woman presented with a long history of grey-blue discoloration of the light-exposed areas. Her face, forearms, and the backs of both hands were affected. The proximal parts of her fingernails were impressively discolored, but her toenails were not affected. The patient reported that she had received oral therapy with the silver-containing drug Gastrarctin in 1959. The diagnosis of argyria was confirmed by documenting high tissue levels of silver in light-exposed skin. Argyria has become uncommon as medications containing silver are no longer employed and occupational protection for those with exposure to silver salts has become more refined.
A case of argyria in a 14 year-old child caused by abuse of silver containing pulveriser for sore throat is described. The distinctive skin blue gray discoloration that occurs in argyria is due to deposition of silver. Pigmentation is permanent. Self treatment is stigmatized.
One case of agryria is reported that developed after a long-term administration of adsorgan in a patient with dyspeptic manifestations after cholecystectomy. The developed skin syndrome -- ashen-grey discolorization of the skin of the face and bare parts of the hands and the neurological symptoms -- right monoparesis and vestibular-disturbances with clinical manifestations of chronic cholangiohepatitis, pancreatitis and gastroduodentitis -- provided considerable diagnostic difficulties. The problem of argyria is discussed as a state of intoxication in chronic use of silver-containing medicaments. The necessity of differentiating argyria by the internists is stressed upon in order to avoid it as a complication in the administration of drugs-containing silver, adsorgan resp., being applied in the physician's practice.
This article reports the clinical findings in a work force of 30 individuals who were exposed to silver nitrate and silver oxide. Six individuals had argyria and 20 had argyrosis (deposition of silver in the eye). Measurements of blood silver levels were included as part of the examination. The results of this examination generally support the benign nature of argyria, although the question of silver causing a decrement in kidney function and night vision is not settled. Periodic slit lamp examinations as well as monitoring of silver air concentrations are necessary to assure that engineering controls are actually limiting worker exposure to silver.
The conjugate effects of selenium and silver salts were studied in experimental renal argyria. Microanalysis has led to the localization of products of chemical reactions to Se and Ag in tissue sections. After prolonged treatment with Ag salts alone, there was Ag and S deposits in basal membranes. When Se and Ag were used together, the formation of these deposits in glomerular basal membranes was accelerated spectacularly. Electron probe microanalysis has shown that Se replaces S in silver deposits. Compared to its effect on other metals, Se was shown to have a complex action, characterized primarily by its toxic effect, favoring the appearance of symptoms of argyria.
In a 49-year-old man generalised argyria was diagnosed, a systemic dissemination and tissue deposition of silver in the body. The clinical picture was brought about by use of a silver acetate-containing lozenge as a deterrent to smoking. Argyria is characterised by a slate blue-gray discolouration of the skin, particularly in areas exposed to light. Generally, it causes patients a great deal of anguish and embarrassment. Present understanding is that it does not entail non-cutaneous, systemic effects. There is no effective treatment--the discolouration is permanent. Currently, prevention is the only possible measure. Efforts should be made to eliminate the uncontrolled use of silver-containing preparations.
BACKGROUND: Treatment of acute burn wounds with silver sulfadiazine (SSD) has raised concern about potential silver toxicity. Numerous adverse reactions and side effects have been reported and an increasing resistance to SSD, especially in Pseudomonas strains, have motivated researchers to search for an alternative wound dressing. METHODS: Recently, a silver-coated wound dressing Acticoat (Smith & Nephew, Inc.) has become available for use in burn patients. It is a three-ply dressing, consisting of an inner rayon/polyester absorptive core between two layers of silver-coated, high-density polyethylene mesh. In a moist environment, the nanocrystals of silver are released and improve the microbial control in the wound. RESULTS: After 1 week of local treatment with Acticoat in a young, previously healthy 17-year-old boy with 30% mixed depth burns, hepatotoxicity and argyria-like symptoms, a grayish discoloration of the patient's face, appeared. The silver levels in plasma (107 microg/kg) and urine (28 microg/kg) were clearly elevated, as well as the liver enzymes. As soon as the local application of Acticoat was aborted, the clinical symptoms and liver enzymes returned to the normal values. CONCLUSIONS: This is the first report on silver toxicity in a patient with 30% burns who received Acticoat for local treatment. Due to substantial experiences with adverse SSD reactions and side effects, it is appropriate to keep the possibility of a toxic silver effect in burn patients treated with Acticoat silver-coated wound dressing in mind. The silver levels in plasma and/or urine should be monitored.
Generalized argyria, the systemic dissemination and tissue deposition of silver-containing particles, is characterized by slate gray discoloration of skin, most pronounced in sun exposed areas. A 33-year-old woman visited our dermatologic clinic complaining of frequent oral ulceration for 10 years and generalized discoloration of her skin for 5 years. She had had her tongue painted with silver nitrate repeatedly 6 years ago for the treatment of oral ulcers. Physical examination showed slate gray discoloration of her skin, most pronounced on the face and neck. The oral mucosa, tongue, sclera, and conjunctiva also had a slightly blue-gray discoloration. Biopsy specimens from the oral mucosa and forearm revealed small brown-black granules scattered in the dermis and basal lamina of eccrine sweat glands, blood vessels, and hair follicles under the light microscope. Tiny black granules were most numerous in the basal laminae of vessels in electron microscopic observation. Energy dispersive X-ray microanalysis (EDXA) confirmed that many of the granules contained silver.
Microscopic studies have been performed on skin biopsies from five patients with occupational argyria. Small brown-black granules were present in the dermis on light microscopy and were intensely refractile with dark-field illumination. Electron microscopy showed that the granules were electron-dense, round or oval in shape and varied in size from 30 nm to 100 nm. They were most numerous in relation to the basal lamina of the eccrine sweat glands, but were also present in relation to the basal lamina of the epidermis and dermal elastic fibres. X-ray microanalysis confirmed that many of the granules contained silver and sulphur. However, selenium, mercury, titanium and iron were also identified and it is probable that these elements were deposited in the skin also as a result of occupational exposure.
We report an unusual cause of localized cutaneous argyria, due to the cutaneous implantation of a silver earring back.
The case study of a schizophrenic patient with argyria which resulted from the chronic and excessive ingestion of antismoking pills contain silver, is presented. Convulsive seizures developed after the patient had been addicted to the pills for 40 years. An extremely high concentration of silver was detected in serum. This case provides support for the hypothesis that silver may cause convulsive seizures as a result of systemic poisoning.
A 74 year old man presented with signs and symptoms of mild cardiac failure. His face and chest were severely discoloured, which was thought to be due to cyanosis. He deteriorated and died of bronchopneumonia. At post mortem examination multiple organs, including the skin, showed silver pigment deposition; he also had a gastric malignant neuroendocrine tumour. He gave no history of contact with silver compounds. Systemic argyria caused by chronic ingestion of silver compounds is a rare condition which, apart from its cosmetic effects, is thought to be relatively harmless; it is not thought to be carcinogenic. This condition can pose diagnostic problems for both clinicians and pathologists.
A patient with silver earring backings, embedded in the ear lobes for several years, developed blue macules of localized argyria on both sides.
Generalized argyria was precipitated in a patient by treating gingival erosions with a solution of silver nitrate for several months. High silver concentrations were measured in skin biopsies. treatment with penicillamine did not increase the urinary silver excretion, indicating that silver is deposited in tissues in a chemically stable and apparently inert form. Electron microscopy showed that in the kidney, silver was deposited mainly in the basal membranes as electron-dense particles. These particles were studied by using X-ray emission spectrometry and electron diffraction. the particles consisted of Ag2Se in the low temperature orthorhombic alfaform. The lattice parameters are: a = 0.433 nm, b = 0.693 nm and c = 0.784 nm. This selenide complex seems to be remarkably non-toxic, since the renal function of the patient was unaffected and only negligible reactive changes were observed in kidney biopsies.
We report a 66-year-old woman with localized argyria caused by embedding of acupuncture needles. Ten years after she had received acupuncture, she noticed two asymptomatic bluish macules on her right arm. A biopsied specimen from the macule revealed many brownish-black granules mainly located around the sweat glands and the blood vessels in the dermis. The X-ray examination of the extremities revealed numerous needle-like fragments around her extremities. "Embedding of needles" induces some serious adverse events. We should know the adverse events for the safety and health of patients.