Severe silver poisoning (Argyria). A 64 year-old Hispanic female presents to this office with a silver-gray color. The patient is noted to be severely toxic, emaciated, weight of 98 pounds down from her normal weight of 164 pounds. The patient was hypotensive, mildy tachycardic and febrile. The patient was immediately admitted to the ICU in septic shock. The patient was well until about four years prior to coming to the toxicology office. The weight loss was over the last four year period. The patient then started to develop ulcerations and open abscesses on her hands and elbows. The patient says that her co-worker developed the same problems of weight loss within the same period of time and just recently died. No further history was available on the co-worker. The patient's job was described to be that of the person who sent out old 35 mm movies to movie buffs and then on their return, she would take them out of the cardboard box and replace them back into the film library. Due to a history of working with old movies eight hours a day, five days a week for 30 years the urine silver level was obtained. The silver level was 78 μg/L the reference range being less than 5 μg/L. The threshold limit value is 0.1 mg per meter squared for metallic silver. There was an infant whose parents had administered colloidal silver as a nutritional supplement and was admitted elsewhere. The child was treated symptomatically. Elemental silver was found in the feces and the child was discharged in no distress and did well. On admission to the ICU, initial recommendation was for chelation of this 64 year old female who was severely ill. The literature only weakly supported the use of DMSA for silver toxicity. The ICU team elected to treat this patient aggressively for sepsis and hypotension. In depth work up for cancer was negative. The patient had a prolonged and stormy hospitalization and was released for outpatient treatment for hand infections. One year later, the patient re-presented to the toxicology office with her weight having gone from an initial weight of 93 pounds to 154 pounds an appeared to be robust. The patient had resolving infections on her hands and elbows. This is an example of toxicity from silver that was obtained from working with movies from the era of the, “silver screen.”
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