title: Pauci Immune crescentic glomerulonephritis in a patient with T-cell lymphoma and argyria.
abstract: Silver is a transition metal, toxic when ingested in significant amounts, causing argyria (skin deposition) and argyrosis (eye deposition). It is excreted mainly via the gastrointestinal tract with only small amounts eliminated by the kidneys, and rarely have cases of nephrotoxicity due to silver been reported. Here we present the case of a woman who used colloidal silver as an alternative remedy for a T cell lymphoma, who subsequently developed argyria and a pauci-immune crescentic glomerulonephritis with evidence of extensive glomerular basement membrane silver deposition.
  
  
  
  A 47 year old woman of Indo-Asian descent with a T-cell lymphoma who refused conventional chemotherapy for 18 months but self-medicated with a remedy containing colloidal silver, was admitted with acute dialysis-dependent kidney injury. A kidney biopsy demonstrated a pauci-immune crescentic glomerulonephritis with deposition of silver particles in the mesangium and along the glomerular basement membranes. The patient was treated with intravenous methylprednisolone and intravenous cyclophosphamide and recovered independent renal function.
  
  
  
  Chronological evolution of the the pauci-immune glomerulonephritis suggests that a cellular immune-mediated process was induced, potentially mediated by lymphomatous T cells directed at the glomerular basement membrane, following silver deposition. Immunosuppressive therapy improved the situation and allowed cessation of haemodialysis, supporting the hypothesis of an immune-mediated process.
authors.affiliation: UCL Centre for Nephrology, Royal Free London NHS Foundation Trust, Rowland Hill Street, London, NW3 2PF, UK. t.rezk@ucl.ac.uk.
authors.forename: Tamer
authors.initials: T
authors.lastname: Rezk
authors.affiliation: UCL Centre for Nephrology, Royal Free London NHS Foundation Trust, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: James
authors.initials: J
authors.lastname: Penton
authors.affiliation: UCL Centre for Nephrology, Royal Free London NHS Foundation Trust, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Stevenson
authors.affiliation: Department of Histopathology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
authors.forename: Mared
authors.initials: M
authors.lastname: Owen-Casey
authors.affiliation: Trinity Health Kidney Centre, Institute of Molecular Medicine, St James's Hospital campus, Dublin, D08 W9RT, Ireland.
authors.forename: Mark
authors.initials: M
authors.lastname: Little
authors.affiliation: UCL Centre for Nephrology, Royal Free London NHS Foundation Trust, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: John
authors.initials: J
authors.lastname: Cunningham
authors.affiliation: UCL Centre for Nephrology, Royal Free London NHS Foundation Trust, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Salama
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D001129:Argyria / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D006801:Humans; D016399:Lymphoma, T-Cell / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D012834:Silver / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: C586932:colloidal silver; D012834:Silver
keywords: AKI; Argyria; Glomerulonephritis; Immunosuppression; Silver; Toxicity