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01.12.2016 | Case report | Ausgabe 1/2016 Open Access

BMC Nephrology 1/2016

Pauci Immune crescentic glomerulonephritis in a patient with T-cell lymphoma and argyria

Zeitschrift:
BMC Nephrology > Ausgabe 1/2016
Autoren:
Tamer Rezk, James Penton, Anna Stevenson, Mared Owen-Casey, Mark Little, John Cunningham, Alan D. Salama
Wichtige Hinweise
Tamer Rezk and James Penton are joint first authors.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MC reported biopsy and organised silver analysis. JC and ML contributed to patient management and contributed to manuscript. ADS managed the patient, conceived the study and edited and reviewed the manuscript. RT, AS and JP wrote the first and last drafts of the manuscript. All authors read and approved the final version of the manuscript.

Abstract

Background

Silver is a transition metal, toxic when ingested in significant amounts, causing argyria (skin deposition) and argyrosis (eye deposition). It is excreted mainly via the gastrointestinal tract with only small amounts eliminated by the kidneys, and rarely have cases of nephrotoxicity due to silver been reported. Here we present the case of a woman who used colloidal silver as an alternative remedy for a T cell lymphoma, who subsequently developed argyria and a pauci-immune crescentic glomerulonephritis with evidence of extensive glomerular basement membrane silver deposition.

Case Presentation

A 47 year old woman of Indo-Asian descent with a T-cell lymphoma who refused conventional chemotherapy for 18 months but self-medicated with a remedy containing colloidal silver, was admitted with acute dialysis-dependent kidney injury. A kidney biopsy demonstrated a pauci-immune crescentic glomerulonephritis with deposition of silver particles in the mesangium and along the glomerular basement membranes. The patient was treated with intravenous methylprednisolone and intravenous cyclophosphamide and recovered independent renal function.

Conclusion

Chronological evolution of the the pauci-immune glomerulonephritis suggests that a cellular immune-mediated process was induced, potentially mediated by lymphomatous T cells directed at the glomerular basement membrane, following silver deposition. Immunosuppressive therapy improved the situation and allowed cessation of haemodialysis, supporting the hypothesis of an immune-mediated process.
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