Argyria Induced by Prolonged Ingestion of Silver Ionized Water: A Scanning Transmission Electron Microscopy With Energy-Dispersive X-Ray Analysis Utilizing a Simplified Sample Preparation Method.

Argyria, characterized by irreversible bluish-gray skin pigmentation due to silver accumulation, presents significant cosmetic concerns. Scanning transmission electron microscopy (STEM) combined with energy-dispersive X-ray spectroscopy (EDS) allows for precise identification of silver particles in tissue; however, standard specimen preparation protocols are labor-intensive. This study evaluates the feasibility, diagnostic utility, and limitations of a simplified STEM-EDS method using conventionally prepared transmission electron microscopy (TEM) specimens. A 72-year-old man with a two-year history of ingesting silver-ionized water three times daily presented with diffuse blue-brown pigmentation of the facial skin and nails. Based on clinical suspicion of systemic argyria, skin biopsy samples were analyzed using STEM-EDS on ultrathin sections prepared via standard TEM protocols. Granules approximately 200-400 nm in diameter exhibited distinct EDS emission peaks for silver and selenium. Elemental line scans revealed silver as the primary component, and areal mapping confirmed the co-localization of silver and selenium within the same granules. This case highlights the diagnostic utility of STEM-EDS in confirming silver deposition in suspected systemic argyria, even when using standard TEM-prepared samples. The streamlined approach eliminates the need for additional specimen processing while maintaining analytical integrity.