- Purple or Purple/Grey
- Argyria is the discolouration of the skin from chronic contact with, or ingestion of, silver salts. It is common amongst workers in the silver industry (mining, refinery, silverware, electroplating and photography) through prolonged skin exposure, and in those whom take colloidal silver preparations orally as health tonics. Other exposures include medication with silver salts, especially nasal or urethral irrigation drops, surgical and dental procedures (silver sutures in abdominal surgery and silver dental fillings).
- Rosemary Jacobs (pictured below at 36) has lived with silver skin for 60 years after she was given nose drops containing silver when she was 11 years old. [Reference]
- Infantile acrodynia.
- Pink disease was especially common in the first half of the 20th century. Infants and small children would present with CNS symptoms (irritability, light sensitivity, hyperhidrosis, hypotonia, ataxia), gastrointestinal symptoms (weight loss, reduced appetite), anaemia, swelling and marked reddening of the extremities (from where the name was derived), especially the palms and soles.
- There was a relatively high fatality rate, anywhere from 10-33%. Children were typically admitted and, if they survived, gradually improved to a near total recovery. Initially, Pink disease was thought to be due to a nutritional deficiency that was gradually corrected whilst in hospital, however later investigations in the 1940s and 50s revealed the true aetiology to be mercury poisoning. Mercury was a common ingredient of teething powders at the time. [Reference]
- ‘Chronic bronchitis’ vs ‘emphysema’ in COPD [Reference]
- Coal workers’ pneumoconiosis
- Chronic inhalation of coal dust leads to the development of chronic bronchitis, chronic airflow limitation and emphysema.
- Inhaled coal dust can settle in terminal bronchioles where the carbon is engulfed by alveolar and interstitial macrophages, which are then expelled in respiratory mucus or through the lymphatic system. When this simple system is overwhelmed by the load of inhaled coal dust, dust laden macrophages may trigger an immune response and progressive fibrosis.
- Fibrosis associated with coal dust exposure is however considerably less intense and extensive than that caused by the more bioactive dusts, such as silica and asbestos. [Reference]
- 5 (not just Vancomycin)
- Naturally, Vancomycin is by far the most common cause of Red man syndrome, however, ciprofloxacin, amphotericin B, rifampacin and teicoplanin can also potentially cause the reaction.
- Red man syndrome is an infusion-related reaction, histamine mediated hypersensitivity reaction. It typically consists of pruritus and erythema to the face, neck, and upper torso. Less frequently, hypotension and angioedema can occur.
- Signs of red man syndrome often appear about 4–10 min after an infusion started or may begin soon after its completion. It is often associated with rapid (< 1 hour) infusion of the first dose of vancomycin, although it can occur after multiple doses. It is more common in those under 40, and especially common in children.
- Like vancomycin, the other four antibiotics are capable of causing direct degranulation of mast cells and basophils. Red man syndrome is amplified if these antibiotics are combined with vancomycin or with each other. [Reference]