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Thursday, 6 February, 2025
HomeCase StudyMystery of patient whose skin turned grey

Mystery of patient whose skin turned grey

In an unusual case that continues to baffle Hong Kong hospital specialists, a man (84) who presented with complications from a urinary flow obstruction left clinicians perplexed over a seemingly unrelated greyness to his skin, eyes and nails.

The unusual colour was far from new. In fact, his faint ashen hue reportedly appeared a whole five years previously.

Blood tests soon revealed the culprit – silver. At concentrations more than 40 times than found in most individuals, the man’s body was positively saturated with the metal, causing it to bead into tiny oxidised granules just beneath his skin in the membranes of his sweat glands, blood vessels and dermal fibres.

Known as argyria, the systemic build-up of silver in body tissues is rare, but far from unknown. In extreme cases individuals can be left with large areas of exposed skin that appear strikingly blue.

Historically, the condition affected artisans and miners who worked closely with the metal, yet in a number of cases, the element was absorbed from medications that incorporated silver for its antimicrobial properties.

Colloidal silver continues to be used without scientific evidence supporting its efficacy, with the US Food and Drug Administration warning the ingredient is not currently considered a safe or effective means of treating any disease or condition.

That isn’t to say “treatments” based on silver aren’t readily available around the world, often marketed as dietary supplements that claim to help expel toxins or aid the body’s defences.

The metal is commonly absorbed internally through the lungs, skin, or digestive system as a charged particle, depositing far and wide as it is transported throughout the body.

Wherever UV radiation from sunlight can reach, the silver ions can catch an electron and transform it into a form that can react to form compounds that reflect a dull grey or blue colour.

The 84-year-old was being treated for a benign prostate tumour, though his only medication was a common antiandrogen called finasteride, which ought to contain nothing even remotely like silver.

Having worked for years as a waiter, the patient offered no obvious source of silver contamination in his workplace. Without any of his neighbours presenting with similar changes in skin colour, exposure in his home environment was also unlikely.

Fortunately the condition is unlikely to have a significant impact on his long-term health. Aside from the subtle cosmetic effects, silver build-up is relatively benign at all but the highest of concentrations, at most, potentially affecting the absorption of some antibiotics and drugs such as thyroxine.

That said, the man is likely to have a hard time getting rid of his slate-grey tone if he wants to. There are no known measures that can eliminate a build-up of silver from the body.

Just where it came from remains a mystery, for now. With a diagnosis in his medical record, however, the patient's physicians will no doubt keep a close eye on his silver status for years to come.

The case study was published in the New England Journal of Medicine.

Study details

Argyria

Tin Yan Lee and Wan Hang Lau.

Published in the NEJM on 8 January 2025

Abstract

An 84-year-old man with benign prostatic hyperplasia who had been admitted to the hospital with acute kidney injury due to obstructive uropathy was noted to have gray skin. The skin changes had been present for five years, during which time his only medication had been finasteride. On physical examination, diffuse slate-gray pigmentation of the skin, particularly on the face, hands and nails, and sclera, was seen. A serum silver level was 423 nmol per litre (reference value, <10). A skin biopsy revealed small, dark granules in the basement membrane of sweat glands hematoxylin and eosin staining) and in pilosebaceous units, blood vessels, and elastic fibres in the dermis. A diagnosis of generalised argyria was made. Generalised argyria is caused by systemic silver exposure leading to an irreversible darkening of skin pigmentation. The changes in skin colour are most prominent in sun-exposed areas, because sunlight catalyses the reduction of elemental silver. The patient had had no meaningful silver exposure in his decades of work as a waiter. He did not use silver-containing products, such as colloidal silver. No other residents in his apartment building had had changes in skin colour. On discharge, the patient was referred for further toxicologic evaluation. Ultimately, the source of silver exposure was not identified.

 

NEJM article – Argyria (Restricted access)

 

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