title: Rapid onset of argyria induced by a silver-containing dietary supplement.
abstract: We describe a 53-year-old man in good general health who presented with an 8-month history of progressive gray hyperpigmentation of the face. He denied using any prescription medications; however, he admitted to taking a herbal supplement. Clinically, the differential diagnosis included hemochromatosis, Wilson's disease and hyperpigmentation secondary to supplement use. Punch biopsies from the left forehead and preauricular region showed heavily sun-damaged skin with a minimal inflammatory infiltrate. Closer inspection, however, revealed minute scattered black/brown particles distributed in the basement membrane zone of eccrine and sebaceous glands. Similar particles were also present in hair follicles, blood vessels and arrector pili muscles. The particles did not stain with Gomori methenamine silver, Fontana-Masson or iron stains. Electron microscopy with energy-dispersive x-ray analysis showed numerous particles, less than 1 µm in greatest dimension, which showed peaks for silver and sulfur. This analytical result confirmed the impression of argyria. Further history revealed that the patient had indeed been taking a silver supplement for several months under the premise that it would boost his immune system. This case is unique in that the patient's hyperpigmentation developed in a short period of time as compared with other reports in the medical literature.
authors: Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC 20307, USA. pete.bowden@me.com
authors: Lynden P
authors: LP
authors: Bowden
authors: Michael C
authors: MC
authors: Royer
authors: James R
authors: JR
authors: Hallman
authors: Michael
authors: M
authors: Lewin-Smith
authors: George P
authors: GP
authors: Lupton
mesh_terms: D001129:Argyria / Q000209:etiology* / Q000473:pathology; D019587:Dietary Supplements / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012835:Silver Nitrate / Q000009:adverse effects*; D012867:Skin / Q000187:drug effects* / Q000473:pathology; D013997:Time Factors
chemical_list: D012835:Silver Nitrate