Generalized argyria in two chronic hemodialysis patients

Silver can be absorbed through ingestion, topical administration, or inhala tion. Generalized argyria results from deposition of silver in the skin, na ils, mucous membranes, and internal organs and is characterized by a diffus e bluish-gray discoloration in sun-exposed areas. We report two cases of ge neralized argyria in patients on maintenance hemodialysis (PID) therapy for more than 15 years. They presented with diffuse hyperpigmentation of the f ace that was mistaken to be related to uremia and bluish-gray discoloration of all nails believed to be cyanosis. Histopathologic examination of skin biopsy specimens showed characteristic findings of argyria, which was furth er confirmed by radiograph microanalysis. Their serum silver levels were al so elevated. No definite silver source could be determined. However, their argyria might be related to their long-term HD therapy because (1) they had been on HD therapy for more than 15 years and the discoloration appeared s everal years afterward, and (2) the water used for HD was not well processe d in the early 1980s in Taiwan, Argyria should be suspected in chronic HD p atients presenting with a diffuse bluish-gray discoloration of the skin and nails and evaluated carefully by skin biopsy. (C) 2001 by the National Kid ney Foundation, Inc.