Unintentional silver intoxication following self-medication: an unusual case of corticobasal degeneration

Abstract

Silver toxicity is a rare condition. The most notable feature is a grey-blue discoloration of the skin, argyria, although harmful effects on the liver and kidney may be seen in severe cases. Neurological symptoms are an unusual consequence of silver toxicity. So far no effective treatment has been described for this metal overdose. We report the case of a 75-year-old man who had a history of self-medication with colloidal silver and presented with myoclonic seizures. 2009; 46: 520-522. DOI: 10.1258 46: 520-522. DOI: 10. /acb.2009 Case A 75-year-old male, former electronic engineer, was admitted to hospital with fever, a chest infection and myoclonic seizures. He had a four-year history of a gradually progressive neurodegenerative disorder characterized by asymmetrical parkinsonism and myoclonic jerks initially affecting the left upper limb. There had been some progression of the akinetic-rigid symptoms to the right side and he had developed some alien limb phenomena in the left arm accompanied by a prominent grasp reflex. On the basis of these clinical findings, a diagnosis of corticobasal degeneration had been made. Although he had been treated with a combination of dopamine agonists and levodopa, there had been little clinical response. In the 12 months prior to this admission, he had increasing difficulty swallowing and was hospitalized on several occasions with probable aspiration pneumonia. Other significant past medical history included ischaemic heart disease, mild asthma and non-insulin-dependent diabetes mellitus. His medications at presentation included co-beneldopa (levadopa and benserazide), ropirinole, simvastatin, aspirin and ramipril. Ann Clin BiochemAt admission to hospital, signs of a highly asymmetric ( predominantly left sided) akinetic-rigid syndrome were confirmed. In addition, frequent and sustained myoclonic jerky movements of the left upper limb were noted. There were signs of a right-sided lower respiratory tract infection but examination of the cardiovascular and gastrointestinal systems were essentially unremarkable. An inconsistent failure of ocular pursuit movements was noted later in the course of his admission and apart from his dysphagia, no other cranial nerve abnormalities were apparent. There was no pyramidal weakness and there was no discoloration of the patient's skin. The sclerae and mucosae were normal in appearance.A series of analytical investigations were performed. The majority were within reference ranges except for the serum selenium of 0.58 mmol/L (reference range: 0.89 -1.65). A chest X-ray confirmed that there was patchy air space and peribronchial shadowing in the right mid and upper zones consistent with infective change. The results of computed tomography of the head showed generalized brain volume loss and mild periventricular chronic ischaemic changes. Magnetic resonance imaging of the brain showed changes consistent with moderate global cerebral atrophy, with more pronounced widening of parietal sulci. Signal changes were noted in the pons and the pos...

Acute and subchronic dermal toxicity of nanosilver in guinea pig

“…It may induce hepatotoxicity or renal toxicity and may lead to death in some cases of extreme exposure to a certain dose of Ag + . 24 We have shown that silver nanoparticles with properties similar to those of Ag + could be translocated in the body and cause histopathologic changes in the liver and spleen unlike those caused by AgNO 3 given by the same route of administration. For example, mononuclear inflammation was noted for AgNO 3 -treated animals only, whereas reduced epidermal thickness and thickness of papillary layer were seen after administration of different concentrations of nanosilver in our acute study.…”

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.…”

“…Two thirds of the patients presented with cutaneous involvement, while 20% presented with blue lunulae only. Importantly, the remaining 13% (two patients) did not present with argyria but rather suffered from myoclonic seizures 14,18 . One of these patients fell into a persistent vegetative state and died about 6 months after presentation 14 .…”

Untitled

“…Stepien et al [25] & Korani et al [26] study showed fatal consequences in higher dose Silver nitrate oral gavages administration along with liver, kidney and spleen toxicity histopathologically in medium dose administration, but still complete evidences are not available in plenty manner on teratogenicity of the silver compound on skeletal system. The present work was undertaken to study the effect of prenatal exposure of silver nano particle colloidal solution through repeated oral gavages on developing skeleton of mice embryos.…”