Kim Yangho, Suh Ho Seok, Cha Hee Jeong, Kim Suk Hwan, Jeong Kyoung Sook, Kim Dong Hoon
Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Am J Ind Med. 2009 Mar;52(3):246-50. doi: 10.1002/ajim.20670.
A 58-year-old woman was referred to our hospital due to progressive skin darkening, which began 5 months previously. The patient had strikingly diffuse blue-gray discoloration of the skin, most prominent in sun-exposed areas, especially her face and hands. The oral mucosa, tongue, gums, eye conjunctiva, ears, nail beds, and trunk were also involved. Bluish-gray discoloration of all nails was aggravated by cold weather. She had ingested 1 L of colloidal silver solution daily for approximately 16 months as a traditional remedy. Her serum silver concentration was 381 ng/ml which was a very high (reference level: <15 ng/ml). Light microscopic examination of a punch biopsy specimen from her nose revealed fine, minute, round, and brown-black granules deposited in the basement membrane of hair follicular epithelium. Scanning electron microscopic examination showed electron-dense granules deposited in the intercellular space of sweat glands. Energy disperse X-ray spectrometry analysis demonstrated peaks for silver and sulfur in the dense black deposits. The ingestion of colloidal silver appears to be an increasing practice among patients using alternative health practices. All silver-containing products including colloidal silver should be labeled with a clear warning to prevent argyria, especially in alternative health practices.
一名58岁女性因5个月前开始出现的皮肤进行性变黑被转诊至我院。患者皮肤有明显的弥漫性蓝灰色色素沉着，在暴露于阳光的部位最为明显，尤其是面部和手部。口腔黏膜、舌头、牙龈、眼结膜、耳朵、甲床和躯干也受累。所有指甲的蓝灰色色素沉着在寒冷天气下会加重。她每天摄入1升胶体银溶液约16个月作为一种传统疗法。她的血清银浓度为381 ng/ml，这是一个非常高的水平（参考水平：<15 ng/ml）。对其鼻部的钻孔活检标本进行光镜检查发现，细小、微小、圆形的棕黑色颗粒沉积在毛囊上皮的基底膜中。扫描电子显微镜检查显示电子致密颗粒沉积在汗腺的细胞间隙中。能量色散X射线光谱分析表明，致密黑色沉积物中有银和硫的峰。在使用替代健康疗法的患者中，摄入胶体银的情况似乎越来越普遍。所有含银产品，包括胶体银，都应贴上明确的警告标签，以预防银质沉着病，尤其是在替代健康疗法中。
