만성 신부전 환자에서 은단 복용과 동반되어 발생한 전신적 은 중독증 1예

Abstract

Generalized hyperpigmentation has a wide range of causes, including endocrine diseases, uremia, drugs, and heavy metals. Cutaneous pigmentation observed in 70% of uremic patients on hemodialysis. However, it is clinically difficult to define the exact cause of hyperpigmentation in chronic renal failure patients. We experienced a case of cutaneous hyperpigmentation caused by generalized argyria in chronic hemodialysis patient. A 38-year-old male patient presented with slowly progressive blue-black discoloration of skin. He had been on maintenance hemodialysis for 5 years and took sliver pills 36 g daily during 2.5 years to relieve thirst. The other source of silver exposure could not be determined. Pathologic examination of skin biopsy specimen showed focal deposits of fine, uniform, brownish granules along the basement membrane zone of hair in the dermis, which is characteristic findings of argyria. The silver deposits were also confirmed by increase in serum silver level and silver amount in liver and skin tissue. Argyria should be suspected in chronic hemodialysis patients presenting with a diffuse bluish-gray discoloration of the skin and nails and evaluated carefully by skin biopsy with quantitation of tissue silver level.