Generalized argyria in two chronic hemodialysis patients

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
Y M SueJ J Huang

Abstract

Silver can be absorbed through ingestion, topical administration, or inhalation. Generalized argyria results from deposition of silver in the skin, nails, mucous membranes, and internal organs and is characterized by a diffuse bluish-gray discoloration in sun-exposed areas. We report two cases of generalized argyria in patients on maintenance hemodialysis (HD) therapy for more than 15 years. They presented with diffuse hyperpigmentation of the face that was mistaken to be related to uremia and bluish-gray discoloration of all nails believed to be cyanosis. Histopathologic examination of skin biopsy specimens showed characteristic findings of argyria, which was further confirmed by radiograph microanalysis. Their serum silver levels were also elevated. No definite silver source could be determined. However, their argyria might be related to their long-term HD therapy because (1) they had been on HD therapy for more than 15 years and the discoloration appeared several years afterward, and (2) the water used for HD was not well processed in the early 1980s in TAIWAN: Argyria should be suspected in chronic HD patients presenting with a diffuse bluish-gray discoloration of the skin and nails and evaluated carefully by skin biopsy.

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Citations

Jul 2, 2011·International Journal of Nanomedicine·M KoraniS Adeli
Nov 2, 2013·Indian Journal of Dermatology, Venereology and Leprology·Asha KubbaTanvi Pal
Oct 5, 2010·International Journal of Dermatology·In-Sung ChungHye-Ra Jung
Sep 24, 2004·Physics in Medicine and Biology·S A Graham, J M O'Meara
Dec 3, 2013·Chemical Society Reviews·Loris Rizzello, Pier Paolo Pompa
Apr 24, 2018·The American Journal of Dermatopathology·Angel Fernandez-FloresDavid Cassarino Cassarino
Mar 9, 2017·Frontiers in Chemistry·Bryan Calderón-JiménezJosé R Vega Baudrit
Jun 3, 2021·Journal of Clinical Medicine·Luís Mota, Ricardo Jorge Dinis-Oliveira
Mar 16, 2013·Chemical Reviews·Sonja EckhardtKatharina M Fromm

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