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

Citations to this article as recorded by

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A Case of Argyria from Silver in Cellular Phone Case Manufacture: Ki Hong Tak, Seok Hwan Yoon, Mi Young Lee, Dong Hoon Shin, In Sung Chung; Korean Journal of Occupational and Environmental Medicine 2006;18(4):339-344. Published online December 31, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.4.339

Abstract PDF: BACKGROUND
Skin contact with, and the breathing in of air containing silver compounds can occur in the workplace. Occupational exposure to silver and its compounds is mainly via airborne dust, metal fumes, and mists of solutions containing silver compounds. Argyria results from increased serum silver levels and the deposition of silver-containing particles in the dermis and mucous membranes. The author reports a patient with generalized argyria, who worked on the manufacture of cellular phone cases.
CASE
REPORT: The patient was a 30 year-old male, with extensive blue-gray discoloration of the whole body, especially sun-exposed area, of 3 years duration. He had been exposed to silver in the processing of EMI for the past 4 years and gaskets for 1 year. EMI is the process by which the internal electromagnetic wave in cellular phone cases are shielded, and gaskets play an important role in shielding the electric clashes between electronic circuits, as well as increasing the durability of cellular phone cases to impact. EMI had been processed manually but this was changed to automatic spraying by robots in 2003. On physical examination, the patient had diffuse blue-gray discoloration of the skin, which was most prominent in the sun-exposed areas of his face, neck and V of the chest. Histopathological examination of a punch biopsy specimen from the posterior neck revealed fine, minute, round, and brown-black granules deposited in the basement membrane zone surrounding the eccrine glands. The laboratory findings were positive for hepatitis B antigen, with a serum silver concentration of 150.3 ppb. From this evidence, he was diagnosed with argyria due to silver exposure.
DISCUSSION
The author reports a case of occupational systemic argyria due to inhalation exposure of silver compounds.

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