Annals of Occupational and Environmental Medicine

Case Reports

A case of generalized argyria presenting with muscle weakness: Inha Jung, Eun-Jeong Joo, Byung seong Suh, Cheol-Bae Ham, Ji-Min Han, You-Gyung Kim, Joon-Sup Yeom, Ju-Yeon Choi, Ji-Hye Park; Ann Occup Environ Med 2017;29:45. Published online October 2, 2017; DOI: https://doi.org/10.1186/s40557-017-0201-0

Background

Argyria is a rare irreversible cutaneous pigmentation disorder caused by prolonged exposure to silver. Herein, we report a case of generalized argyria that developed after chronic ingestion of soluble silver-nano particles and presented with muscle weakness.

Case presentation

A 74-year-old woman visited our emergency room, complaining of fever and mental deterioration. She was diagnosed with acute pyelonephritis and recovered after antibiotic therapy. At presentation, diffuse slate gray-bluish pigmented patches were noticed on her face and nails. Two months prior to visiting our hospital, she was diagnosed with inflammatory myopathy and given steroid therapy at another hospital. We performed a nerve conduction study that revealed polyneuropathy. In skin biopsies from pigmented areas of the forehead and nose, the histopathologic results showed brown-black granules in basement membranes of sweat gland epithelia, which are diagnostic findings of argyria. We reviewed pathology slides obtained from the left thigh muscles and found markedly degenerated myofibers with disorganization of myofibrils without inflammatory reactions, consistent with unspecified myopathy, rather than inflammatory myopathy. The patient was diagnosed with generalized argyria with polyneuropathy and myopathy and transferred to a rehabilitation institution after being tapered off of steroids.

Conclusions

Clinicians should be aware of clinical manifestations of argyria and consider it in differential diagnosis when they examine patients who present with skin pigmentation and muscle weakness.

Citations

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Blue Nail Discoloration: Literature Review and Diagnostic Algorithms
Jonathan K. Hwang, Shari R. Lipner
American Journal of Clinical Dermatology.2023; 24(3): 419. CrossRef
Systemic argyria with severe anemia (hemoglobin 2.4 g/L)
Nathan Chow, Kristen Fain, Jay Truitt, Cloyce Stetson
Baylor University Medical Center Proceedings.2022; 35(3): 382. CrossRef
Pigmentación exógena por nitrato de plata: aspectos dermatológicos y toxicológicos, a propósito de un caso
Ángela Londoño, Camila Pérez, Rodrigo Restrepo, Nathalie Morales, Miguel Martínez, Daniela Morales
Biomédica.2021; 41(2): 234. CrossRef
Clinical and Forensic Aspects of the Different Subtypes of Argyria
Luís Mota, Ricardo Jorge Dinis-Oliveira
Journal of Clinical Medicine.2021; 10(10): 2086. CrossRef
The Food Matrix and the Gastrointestinal Fluids Alter the Features of Silver Nanoparticles
Laurie Laloux, Donika Kastrati, Sébastien Cambier, Arno C. Gutleb, Yves‐Jacques Schneider
Small.2020;[Epub] CrossRef
Azure lunulae
Ramón García‐Galaviz, Braulio Martínez‐Benítez, Judith Domínguez‐Cherit
International Journal of Dermatology.2020;[Epub] CrossRef
The impact of bacterial size on their survival in the presence of cationic particles of nano-silver
Samir A. Anuj, Harsukh P. Gajera, Darshna G. Hirpara, Baljibhai A. Golakiya
Journal of Trace Elements in Medicine and Biology.2020; 61: 126517. CrossRef
Bacterial membrane destabilization with cationic particles of nano-silver to combat efflux-mediated antibiotic resistance in Gram-negative bacteria
Samir A. Anuj, Harsukh P. Gajera, Darshna G. Hirpara, Baljibhai A. Golakiya
Life Sciences.2019; 230: 178. CrossRef
N-Acetylcysteine reverses silver nanoparticle intoxication in rats
Monique Culturato Padilha Mendonça, Luiz Bandeira Ferreira, Cintia Rizoli, Ângela Giovana Batista, Mário Roberto Maróstica Júnior, Emanueli do Nascimento da Silva, Solange Cadore, Nelson Durán, Maria Alice da Cruz-Höfling, Marcelo Bispo de Jesus
Nanotoxicology.2019; 13(3): 326. CrossRef
Peripheral neuropathy associated with silver toxicity
Elie Naddaf, Peter J. Dyck, Paul J. Jannetto, David L. Murray, P. James B. Dyck
Neurology.2019; 92(10): 481. CrossRef

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A Case of Polyneuropathy Associated with Methyl Bromide Intoxication: Hyung Jae Lee, Se Won Oh, Jong Seong Lee, Hong Jae Chae, Jai Dong Moon; Korean Journal of Occupational and Environmental Medicine 2007;19(3):238-243. Published online September 30, 2007; DOI: https://doi.org/10.35371/kjoem.2007.19.3.238

Abstract PDF

BACKGROUND
The diagnosis and treatment of intoxication induced by methyl bromide depends on the patient's exposure history. In the present case, the patient showed various neurologic symptoms which were helpful to confirm the diagnosis and to determine the concentration of bromide ion in his body. The reduction rate of bromide ion concentration was another important clue to estimate the patient's health state in treatment.
CASE
REPORT: Some neurologic disorders were manifested in a 35-year-old man who had been engaged in a fumigation company for 12 years. Although he had been complaining of abnormal symptoms for 10 days, he had left his work only 3 days before being admitted to our hospital in serious state via the emergency department. Comprehensive clinical evaluations confirmed he was suffering from polyneuropathy, optic neuropathy and cerebellar signs. We diagnosed his condition as methyl bromide intoxication, and ruled out other possible diseases, after taking his occupational history and evaluating the elevation of bromide ion concentration in the sampled blood, urine and cerebrospinal fluid. With decreasing bromide ion concentration, his abnormal symptoms improved and he was discharged 22 days after admission without any neurologic sequela.
CONCLUSION
This case report confirmed the usefulness of measuring the concentrations of bromide ion in the diagnosis of methyl bromide intoxication. We therefore suggest that the regular measuring of bromide ion concentration be included in the occupation specified health examination.

Citations

Citations to this article as recorded by

Acute Occupational Poisoning in Korea
Hyunjoo Kim, Jia Ryu
The Ewha Medical Journal.2016; 39(4): 99. CrossRef
Compensation for Occupational Neurological and Mental Disorders
Dong-Mug Kang, Inah Kim
Journal of Korean Medical Science.2014; 29(Suppl): S59. CrossRef
Occupational Neurologic Disorders in Korea
Yangho Kim, Kyoung Sook Jeong, Yong-Hun Yun, Myoung-Soon Oh
Journal of Clinical Neurology.2010; 6(2): 64. CrossRef
Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef

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A Case of Peripheral Polyneuropathy Induced by Occupational 2,5-hexanedione Exposure: Seong Yong Cho, Yong Seok Jang, Eun Kyung Choi, Jin Seok Kim, Jay Young Yu, Kuck Hyun Woo, Tae Seong Choi; Korean Journal of Occupational and Environmental Medicine 2007;19(1):73-80. Published online March 31, 2007; DOI: https://doi.org/10.35371/kjoem.2007.19.1.73

Abstract PDF

OBJECTIVES
This study is a case report of 2,5-hexanedione induced occupational peripheral polyneuropathy. We also investigated the peripheral nerve function of all workers who had been exposed to 2,5-hexanedione in the same process.
METHODS
In June, 2006, a 2,5-hexanedione exposed worker complained of both hand numbness. He received neurologic, radiologic, laboratorial and electrophysiologic evaluation, including measurements of workplace environment. Five months after cessation of exposure to 2,5-hexanedione, a follow-up electrophysiologic examination was done. We evaluated the peripheral nerve function of 2,5-hexanedione exposed workers by comparing 13 male 2,5-hexanedione exposed workers who were in same company with the patient and 5 male workers who had not been exposed to 2,5-hexanedione.
RESULTS
Under electrophysiologic examination, there were abnormalities in sensory and motor nerve velocity, terminal latency, and F-latency of both median nerve and ulnar nerve. After 5 months, the patient symptoms and the results of follow-up electrophysiologic examinations were improved. Comparing the 2,5-hexanedione exposed group with the unexposed group, the sensory nerve velocity of the median and ulnar nerves in the exposed group was decreased. The motor nerve velocity of the peroneal nerve, and sensory nerve velocity of the median and sural nerves were decreased. Terminal latency of median, ulnar, peroneal, and tibial nerves in the exposed group were increased compared with the unexposed group(<0.05).
CONCLUSIONS
2.5-hexandione can induce peripheral polyneuropathy in male workers.

Citations

Citations to this article as recorded by

Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef
The Association of Subjective Symptoms of Students and Indoor Air Quality in Private Academic Facilities
Kyung-Sick Jung, Nam-Soo Kim, Jong-Dae Lee, Young HwangBo, Bu-Soon Son, Byung-Kook Lee
Korean Journal of Environmental Health Sciences.2009; 35(6): 468. CrossRef
School Indoor Air Quality and Health Effects
Won-Ho Yang
Korean Journal of Environmental Health Sciences.2009; 35(3): 143. CrossRef

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A case of Peripheral Neuropathy After High Electrical Injury: Jun Seok Son, Chang Ho Chae, Young Wook Kim, Keong Bum Min, Cheol Ho Yi; Korean Journal of Occupational and Environmental Medicine 2006;18(4):345-351. Published online December 31, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.4.345

Abstract PDF: BACKGROUND
With increasing industrial development, opportunities are growing to contact electricity in the workplace or home. Therefore, the risk of electrical accident has been increased gradually. In general, electrical injuries involve the extremities and result in amputation or severe disability of limbs. Delayed spinal cord injury and peripheral neuropathies following electrical accidents are extremely rare.
CASE
REPORT: A 32-year-old man with 10 years working experience at a CRT-monitor manufacturer with repetitive exposures to high voltage current visited our hosipital. He complained of left leg weakness and atrophy, and intermittent pain. The symptoms were progressive. Other symptoms occurred such as nocturia, hesitancy, and weak urinary stream. We examined the patient and conducted EMG, L-spine MRI, neurometer test, isokinetic strength test, and physical examination. The results showed neural injuries due to anterior horn lesions or compression of the left femoral nerve pathway, with a consequent diagnosis of neurogenic bladder.

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A case of peripheral polyneuropathy occurring in a small enterprise processing mobile phone cases: Joo Youn Shin, Jong Han Leem, Yong Kyu Kim, Shin Goo Park, Jee Na Lee, Hwan Chul Kim, Chang Hwan Kim, Kyong Up Cho, Mi Jang; Korean Journal of Occupational and Environmental Medicine 2005;17(2):138-143. Published online June 30, 2005; DOI: https://doi.org/10.35371/kjoem.2005.17.2.138

Abstract PDF

OBJECTIVES
We report a case of n-hexane-induced occupational peripheral polyneuropathy. The patient had been cleaning mobile phone cases using n-hexane for 3 years without proper protection in the workplace.
Method
: Physical examinations, detailed history taking, laboratory studies and electrophysiological study were done. The n-hexane concentration in the ambient air of the workplace was analysed.
RESULTS
The findings of the electrophysiological study revealed that the worker's neurologic symptoms were due to peripheral polyneuropathy. The average n-hexane concentration in the ambient air sampled at the workplace for 59 minutes was 1411.24ppm, from which the 8 hour time-weighted-average(TWA) was estimated as 882ppm. Because other alternative causes for peripheral polyneuropathy were ruled out by laboratory findings and detailed history taking, this TWA level strongly suggested that the disease was caused by n-hexane exposure.
Conclusion
: Although the neuro-toxicity of n-hexane is relatively well known, many problems have been identified in the management of this toxic material in terms of preventing toxic diseases in the workplace. We expect that this case will help in the planning of health management strategies for using n-hexane in the workplace.

Citations

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Changes of 30 years in the recognized occupational diseases of Korea: Lessons from the system change perspective
Kyung Ehi Zoh, Mijin Park, Domyung Paek
Archives of Environmental & Occupational Health.2020; 75(3): 127. CrossRef
Study on the Chemical Management - 2. Comparison of Classification and Health Index of Chemicals Regulated by the Ministry of Environment and the Ministry of the Employment and Labor
Sunju Kim, Chungsik Yoon, Seunghon Ham, Jihoon Park, Songha Kim, Yuna Kim, Jieun Lee, Sangah Lee, Donguk Park, Kwonseob Lee, Kwonchul Ha
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(1): 58. CrossRef
Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef
Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. CrossRef
Occupational Neurologic Disorders in Korea
Yangho Kim, Kyoung Sook Jeong, Yong-Hun Yun, Myoung-Soon Oh
Journal of Clinical Neurology.2010; 6(2): 64. CrossRef

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Original Article

Study on the Progression of Biological Effects of Workers Following Termination of CS2 Exposure: In Cases of Peripheral Polyneuritis and Retinal Change: Y T Yum, K J Kim, S D Kim, E I Lee, H K Park, H R Jung, H K Kwon; Korean Journal of Occupational and Environmental Medicine 1994;6(2):348-363. Published online September 30, 1994; DOI: https://doi.org/10.35371/kjoem.1994.6.2.348

Abstract PDF

The object of this study was to evaluate the possibility of new development of polyneuropathy and microaneurysm in dundus in workers who did not have polyneuropathy and microaneurysm in dundus in the electromyogram(EMG) and ophthalmoscopic examination. The total number of subjects was 144 workers who had the EMG and funduscopic examination done at leat twice. There were two kinds of subjects. The one of subjects was a total of 120 workers who were examined at least twice in their annual health examination for carbon disulfide poisoning. The other subjects were 3 total of 24 volunteer workers who worked in the rayon manufacturing factory. The results were as follows; 1. There was no cases of polyneuropathy or microaneurysm in volunteers. 2. The new cases of polyneuropathy were detected in 12 (14.3%) out of 84 subjects, and those of microaneurysm in fundus were detected in 30 (26.5%) out of 113 subjects. 3. We investigated the variables showing difference between the new cases and other cases who had no polyneuropathy or microaneurysm in fundus in repeated examinations. The both of polyneuropathy and microaneurysm cases had higher commulative exposure index, and most of them were workers in the department of spinning where the concentration of CS0 in air was highest in the rayon manufacturing company. 4. There were no statistically significant variables by logistic regression analysis in the polyneuropathy cases, The cummulative index and the department were the statistically significant variable in the development of microaneurysms. ' 5. Above findings showed that workers who had high exposure history of CS2 as the workers in spinning department, had greater chance to develop the polyneuropathy or microaneurysm. But tHere were some limitations to conclude the association between the CS2 exposure and development of polyneuropatHy or microaneurysm. Limitations are follows short follow-up period, small number of cases, and possibility of measurement error including imperfect sensitivity or specificity of electrodiagnostic test and examiner's difference of ophthalmoscopic examination. Therefore more cases and longer follow-up period are needed to study the progression of polyneuropathy or microaneurysm.

Citations

Citations to this article as recorded by

Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. CrossRef
Carbon Disulfide Poisoning in Korea with Social and Historical Background
Eunil Lee, Soonduck Kim, Haejoon Kim, Kwangjong Kim, Yongtae Yum
Journal of Occupational Health.1996; 38(4): 155. CrossRef

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