Rapid onset of argyria induced by a silver-containing dietary supplement
Rapid onset of argyria induced by a silver-containing dietary supplement
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DOI：
10.1111/j.1600-0560.2011.01755.x
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发表时间：
2011-10-01
影响因子：
1.7
通讯作者：
Lupton, George P.
中科院分区：
文献类型：
--
作者：
Bowden, Lynden P.;Royer, Michael C.;Lupton, George P.
我们描述一名53岁总体健康状况良好的男性，他有面部进行性灰色色素沉着8个月的病史。他否认使用过任何处方药；然而，他承认服用过一种草药补充剂。临床上，鉴别诊断包括血色素沉着症、威尔逊病以及补充剂使用导致的色素沉着。取自左前额和耳前区域的钻孔活检显示皮肤受到严重的日光损伤，伴有极少量炎症浸润。然而，进一步仔细观察发现，在汗腺和皮脂腺的基底膜区分布有微小的散在黑色/棕色颗粒。在毛囊、血管和立毛肌中也存在类似颗粒。这些颗粒用戈莫里六胺银染色、方塔纳 - 马松染色或铁染色均不着色。能量色散X射线分析的电子显微镜检查显示，有许多最大尺寸小于1微米的颗粒，其显示出银和硫的峰值。这一分析结果证实了银质沉着病的印象。进一步询问病史发现，患者确实在认为银补充剂可增强其免疫系统的前提下服用了几个月。该病例的独特之处在于，与医学文献中的其他报道相比，患者的色素沉着在较短时间内形成。
We describe a 53-year-old man in good general health who presented with an 8-month history of progressive gray hyperpigmentation of the face. He denied using any prescription medications; however, he admitted to taking a herbal supplement. Clinically, the differential diagnosis included hemochromatosis, Wilson's disease and hyperpigmentation secondary to supplement use. Punch biopsies from the left forehead and preauricular region showed heavily sun-damaged skin with a minimal inflammatory infiltrate. Closer inspection, however, revealed minute scattered black/brown particles distributed in the basement membrane zone of eccrine and sebaceous glands. Similar particles were also present in hair follicles, blood vessels and arrector pili muscles. The particles did not stain with Gomori methenamine silver, Fontana-Masson or iron stains. Electron microscopy with energy-dispersive x-ray analysis showed numerous particles, less than 1 mu m in greatest dimension, which showed peaks for silver and sulfur. This analytical result confirmed the impression of argyria. Further history revealed that the patient had indeed been taking a silver supplement for several months under the premise that it would boost his immune system. This case is unique in that the patient's hyperpigmentation developed in a short period of time as compared with other reports in the medical literature.