Table 2.
Differential diagnosis for other argyria-mimicking pigmentations of skin and other tissues. GA, generalized argyria; LA, localized argyria.
| Pathological Condition of Xenobiotic | Description | References |
|---|---|---|
| Hemochromatosis | Generalized skin hyperpigmentation (GA) | [40,56,64,69,126,134,167,178,245,246,247] |
| Lead poisoning | Blue line along the gingival margins at the base of the teeth (LA/amalgam tattoo) | [5,7,40,91] |
| Methemoglobinemia/sulfhemoglobinemia | Generalized skin brownish-blue to gray pigmentation (as in cyanosis) (GA) | [4,40,56,126,134,141,178,245,246,248] |
| Toxic melanodermatitis | Hyperpigmented skin lesions (LA, GA) | [132] |
| Minocycline | Blue staining of teeth or blue-gray skin lesions (GA) | [7,64,132,249] |
| Chlorpromazine/Phenothiazines | Slate gray-bluish skin discoloration in sun-exposed areas (GA) | [64,132,178,250] |
| Amiodarone | Slate gray-bluish skin discoloration in sun-exposed areas (GA) | [7,64,125,251] |
| Antimalarial agents | Blue-gray discolorations of the mouth and skin (LA, GA) | [55,79,132,246] |
| Clofazimine | Grayish skin plaques or generalized gray skin pigmentation (LA, GA) | [7,132] |
| Cyanosis/cyanotic heart disease | Generalized skin brownish-blue to gray pigmentation (GA) | [1,8,20,36,40,43,45,53,56,66,69,131,169,178,200,245,246,248,252,253,254,255,256] |
| Nevus | Flat or raised pigmented skin lesion (LA) | [2,71,73,76,82,133,137,164,229,241] |
| End-stage renal disease/uremia | Heterogenous skin lesions (LA, GA) | [36] |
| Melanoma of the skin/conjunctiva/oral mucosa | Pigmented lesion, usually asymmetric, with heterogenous color and time-evolving (LA/amalgam tattoo) | [23,82,92,95,96,100,101,119,133,159,178,188,240,246,257] |
| Chrysiasis | Slate-gray to blue skin pigmentation, especially in sun-exposed areas, nail pigmentation (LA, GA, azure lunula) | [36,64,79,113,178,237,246,258] |
| Iron salts | Brown to red skin lesions (LA) | [79] |
| Ochronosis | Bluish-black skin lesions (LA, GA) | [64,76,113,259,260] |
| Wilson’s disease | Generalized skin hyperpigmentation, Kayser-Fleischer rings (GA, OA) | [55,113] |
| Tobacco (chewing) | Brownish-black staining of the oral mucosa (LA/amalgam tattoo) | [91] |
| Chlorophyll (mouthwash) | Blackening of the tongue (LA/amalgam tattoo) | |
| Sodium perborate (mouthwash) | Blackening of the tongue (LA/amalgam tattoo) | |
| Ariboflavinosis | Diffuse bluish-purple discoloration of the buccal mucosa (GA) | |
| Peutz-Jeghers syndrome | Dark blue-brown hyperpigmented gingival macules (LA/amalgam tattoo) | |
| Addison’s disease | Generalized bronze-like skin pigmentation, diffuse pigmentation of gingiva, tongue, and buccal mucosa (GA) | [53,58,69,91,134,178,214,245] |
| Bismuthosis | Blue-black, sharply limited pigmentation of marginal gingivae, nail pigmentation (LA/amalgam tattoo, GA, azure lunula) | [36,79,91,134,178,246] |
| Mercurialism | Diffuse blue-gray to black gingival pigmentation, nail pigmentation (LA/amalgam tattoo, azure lunula) | [36,79,91,140,178] |
| Arseniasis | Generalized skin hyperpigmentation with hyperkeratosis (GA) | [5,7,79,91] |
| Accidental tattoo | Dark-blue/black macules/patterns (LA) | [133] |