Blue lunulae: Argyria and hypercopprecaemia

Abstract

A 42-year-old woman presented with blue lunulae in association with argyria and hypercopprecaemia. The argyria was caused by the regular ingestion of colloidal silver in water over an extended period of time. The raised copper may have contributed to the nail discolouration, and was believed to be due either to ingestion of copper-containing multivitamin tablets or as an acute-phase reactant. We believe that the ease of access to, and lack of stringent regulatory controls over, food supplements and alternative medicines may cause similar cases in the future. We therefore recommend that all patients should be routinely questioned on their use of over-the-counter preparations and alternative medicines.

Rapid onset of argyria induced by a silver-containing dietary supplement

“…The MEDLINE database was searched using the search terms ‘argyria’ and ‘colloidal silver’. Twenty articles were identified, 15 of which were case reports 2,3,7–19 . The case reports each described one patient, and the remaining manuscripts were review articles or small case series.…”

Acute myeloid leukemia with complex cytogenetic abnormalities associated with long-term use of oral colloidal silver as nutritional supplement – Case report and review of literature

“…15 With longterm use, colloidal silver can cause argyria, deposition of silver in various tissues and organs. To this date, there are still many case reports of argyria [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] as well as neurotoxicity, 15 myoclonic status epilepticus and chronic vegetative state, 33 and acute psychosis 34 being published in the medical literature. This is the first reported case of AML with multilineage dysplasia and complex cytogenetic abnormalities associated with long-term use of oral colloidal silver.…”

A case of generalized argyria after ingestion of colloidal silver solution

“…The patient had ingested approximately 16 g of silver (34 mg/L  1 L/ day  16 months). Her complaints had started 5 months earlier when she would have already consumed 11 g. The dosage of silver required to induce generalized argyria by ingestion varies among previously reported cases, with a range of dosage of 3-60 g of soluble silver salts [Hill and Pillsbury, 1939;Lehnert, 1973;Mittag et al, 1987;Gulbranson et al, 2000;Stadie and Marsch, 2004;Kalouche et al, 2007]. Differences in dosages may depend on the type of silver compounds, the time of the recognition of argyria, the location and the degree of argyria, and the exposure of the skin to light.…”

“…There are only a few case reports of generalized argyria that show both the dose of silver ingested and serum silver concentration. A patient ingesting 1.5 g showed localized argyria (nail bed) with a serum level of only 27.4 ng/ml [Kalouche et al, 2007]. The other patient who had ingested 3.29 g showed generalized argyria (face and nail bed) with a serum level of 85.0 ng/ml [Gulbranson et al, 2000].…”