December 22, 2020
Diagnose This (December 21, 2020)
- Published: December 22, 2020
- By: Joel Murphy, MD
What is your diagnosis in a patient with a particular “gray” appearance to their complexion?
Answer: The light microscopic image of a glomerulus on H&E stain depicts numerous black deposits along glomerular basement membranes and mesangium characteristic of renal argyria. Argyria is a systemic disease caused by the deposition and accumulation of silver or silver salts classically through ingestion. The deposition within the skin and conjunctiva lead to a characteristic “slate grey” complexion. By electron microscopy, glomeruli demonstrate characteristic opaque deposits along glomerular basement membranes predominately along the subendothelial aspect. Of note, an attuned pathologist can suspect this diagnosis even at the grossing bench as the biopsy will show classic “black” glomeruli under the dissecting scope due to the silver deposition.