Argyria or cyanosis

A case of argyria secondary to the prolonged use of nasal drops that contained mild silver protein is presented. The patient was thought to be cyanosed immediately after a total knee replacement. Argyria, its differentiation from cyanosis and its prevention are discussed. The need for a careful drug history is noted.

Argyria

The distinctive blue-gray discoloration that occurs in argyria is due to deposition of silver and a silver-induced increase in melanin. Argyria is pronounced in areas of sun exposure and in the lunulae of the fingernails. Skin biopsy confirms the diagnosis by demonstrating tiny brownish granules in connective tissue surrounding sebaceous glands, in perineural tissue and in arteriolar walls. Pigmentation is permanent but benign. While the incidence of argyria is declining, its recognition remains important.

[Localized intramural silver impregnation of the tongue. Differential diagnosis from malignant melanoma]

A case of localized amalgam-induced argyria at the tip of the tongue is reported and differentiation from malignant melanoma by clinical, radiological aspects and results of light and dark-field illumination microscopy is described.

The ocular manifestations and functional effects of occupational argyrosis

Thirty employees of an industrial plant involved in the manufacture of silver nitrate and silver oxide underwent ophthalmologic evaluation in an effort to evaluate the frequency and extent of ocular argyrosis. The most frequently noted ocular abnormality was pigmentation of the conjunctiva, present in 20 workers; corneal pigmentation occurred in 15 workers. A direct relationship existed between the levels of pigmentation and duration of employment. Ocular pigmentation was seen more frequently than cutaneous pigmentation. Ten workers noted decreased night vision, but electrophysiologic and psychophysiologic studies of seven of these ten workers demonstrated no functional deficits.

Argyria and cyanotic heart disease

A case report in which argyria is mistaken for cyanotic heart disease is described. A discussion of argyria, a benign cosmetic condition resulting from either ingestion or the local application of silver salts or colloidal silver, is presented. It is suggested that by obtaining comprehensive drug histories, maintaining patient profiles, and through patient counseling, pharmacists are in a position to identify and advise on known cases of argyria.