Pauci Immune crescentic glomerulonephritis in a patient with T-cell lymphoma and argyria.

BACKGROUND: 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. CASE PRESENTATION: 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. CONCLUSION: 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.

Optical coherence tomography findings in ocular argyrosis.

A 68-year-old Caucasian man with a remote history of daily colloidal silver ingestion presented for ophthalmic examination in which he was noted to have a distinct slate gray skin discoloration. Funduscopy revealed confluent perimacular drusenoid deposits bilaterally, most of which localized at the level of or anterior to the inner segment ellipsoid band by optical coherence tomography (OCT) imaging. Enhanced depth imaging OCT demonstrated marked choroidal thinning. Fluorescein angiogram displayed a dark or silent choroid. Confirmatory serum silver levels were found to be markedly elevated. This report describes a unique geographic maculopathy with large drusenoid deposits anterior to the ellipsoid layer and severe choroidal thinning in association with ocular argyrosis.

A case of argyria after colloidal silver ingestion.

BACKGROUND: Argyria is often considered an entity of the past, one which has largely disappeared with the cessation of silver usage in oral medications. However, with the practice of colloidal silver ingestion in current "alternative health" treatments, argyria should be considered in the differential diagnosis of blue-gray hyperpigmentation. METHODS: A single case report with clinicopathological correlation. RESULTS: Histological examination of skin biopsy specimen, which showed perieccrine brown-black granules, verified that colloidal silver rather than a prescribed medication was the source of the patient's dyspigmentation.

[Case of membranous nephropathy associated with argyria].

We experienced a case of membranous nephropathy associated with argyria. The patient was a 78-year-old woman who had noticed blue skin of the face and azure lunulae for 8 years. She was admitted to our hospital for edema and proteinuria. She was diagnosed as membranous nephropathy by needle renal biopsy, and treated with prednisolone. Her proteinuria disappeared after 63 days. We investigated the blue skin of her face and azure lunulae. Skin biopsy was performed and black granules deposited in the upper layer of the corium were observed. The granules were identified with silver by EDS (energy-dispersive X-ray spectroscopy) analysis. Membranous nephropathy associated with gold or mercury has been reported, but association with silver has not been reported. We considered that this is a rare case of membranous nephropathy associated with silver.

Myoclonic status epilepticus following repeated oral ingestion of colloidal silver.

The authors report a case of a 71-year-old man who developed myoclonic status epilepticus and coma after daily ingestion of colloidal silver for 4 months resulting in high levels of silver in plasma, erythrocytes, and CSF. Despite plasmapheresis, he remained in a persistent vegetative state until his death 5.5 months later. Silver products can cause irreversible neurologic toxicity associated with poor outcome.

Localized argyria with pseudo-ochronosis.

BACKGROUND: Localized argyria is uncommon and presents clinically as asymptomatic slate gray macules or blue macules resembling blue nevi. Its histopathologic features are usually similar to those of generalized argyria in which silver granules are found most commonly around the eccrine glands, in the walls of blood vessels, and along elastic fibers. Ochre swollen homogenized collagen bundles resembling ochronosis have not been previously described. OBJECTIVE: The purpose of this study is to report a series of 5 patients with localized argyria with the histologic feature of "pseudo-ochronosis." In one patient, biopsy was performed on 2 distinct lesions. METHODS: All patients underwent skin biopsies for light microscopy and darkfield microscopy. In two patients, the biopsy specimens were analyzed with a mass spectrophotometer; scanning electron microscopy and energy-dispersive x-ray analysis were performed. In one patient, the biopsy specimen was decolorized with 1% potassium ferricyanide in 20% sodium thiosulfate. RESULTS: All 5 patients presented with the typical clinical and histologic features of localized argyria. Ochre swollen and homogenized collagen bundles were seen in all cases. In addition, light microscopy in 4 cases revealed an ellipsoid black globule within a zone of collagen degeneration. CONCLUSION: The histologic features of localized argyria include swollen and homogenized collagen bundles resembling ochronosis, "pseudo-ochronosis," which may be more common than previously recognized.

Argirisiss localizada: presentacion inusual / Localized argyria: unusual presentation

Presentamos el caso de una niña con argiria localizada en el lóbulo de la oreja, debida a la implantación de la tuerca de un aro de plata

Argirisiss localizada: presentacion inusual / Localized argyria: unusual presentation

Presentamos el caso de una niña con argiria localizada en el lóbulo de la oreja, debida a la implantación de la tuerca de un aro de plata(AU)

Systemic argyria.

A 74 year old man presented with signs and symptoms of mild cardiac failure. His face and chest were severely discoloured, which was thought to be due to cyanosis. He deteriorated and died of bronchopneumonia. At post mortem examination multiple organs, including the skin, showed silver pigment deposition; he also had a gastric malignant neuroendocrine tumour. He gave no history of contact with silver compounds. Systemic argyria caused by chronic ingestion of silver compounds is a rare condition which, apart from its cosmetic effects, is thought to be relatively harmless; it is not thought to be carcinogenic. This condition can pose diagnostic problems for both clinicians and pathologists.

Immunohistochemical demonstration of pancreatic secretory trypsin inhibitor in gynecologic tumors.

Pancreatic secretory trypsin inhibitor (PSTI) is a specific trypsin inhibitor secreted by the acinar cells of the pancreas. Serum levels of immunoreactive PSTI have been reported elevated in patients with various malignancies including gynecologic tumors. The immunohistochemical localization of PSTI is studied in the comparison with argyrophilia and amylase immunoreactivity on 100 ovarian tumors, 35 endometrial carcinomas, and 34 cervical carcinomas. PSTI was noted in 19 of 85 common epithelial tumors of the ovary, being most frequently in mucinous tumors and less in endometrioid, but only occurred in immature pancreatic tissue of 1 of 15 germ cell tumors tested. In the uterus, 5 of 19 adenocarcinomas of the endometrium and 3 of 10 adenocarcinomas of the cervix were positive for PSTI immunoreactivity. PSTI was found more frequently in the tumors with argyrophil cells, especially of type I, but was related to the intestinal metaplasia and exocrine secretion rather than argyrophilia itself, judging from the different localization of PSTI and argyrophilic granules. No relationship was observed between amylase and PSTI immunoreactivity.