Peripheral neuropathy associated with silver toxicity

Silver is known to be a potent bactericidal agent. It has a proinflammatory effect by inducing inflammatory cytokines and reactive oxygen species. Silver can also have a direct cytotoxic effect on immune cells and can cause endothelial cell injury.¹ At low levels, silver is thought to be nontoxic. It only deposits in the skin and causes a silver-blue discoloration called argyria. Lately, there has been an increase in the use of silver nanoparticles as antimicrobial agents or via alternative medicine, which reignited interest in further studying silver toxicity. In the CNS, silver can disrupt the blood–brain barrier and be toxic to neurons and astrocytes.¹ There have been case reports of silver toxicity associated with seizures, cortical basal degeneration, and psychosis.^2–4 On the other hand, the effect of silver on the peripheral nervous system remains poorly explored. In this report, we present a case of a peripheral neuropathy associated with argyria with detailed clinical, laboratory, and histopathologic findings.