Localized argyria with pseudo-ochronosis.
BACKGROUND
Localized argyria is uncommon and presents clinically as asymptomatic slate gray macules or blue macules resembling blue nevi. Its histopathologic features are usually similar to those of generalized argyria in which silver granules are found most commonly around the eccrine glands, in the walls of blood vessels, and along elastic fibers. Ochre swollen homogenized collagen bundles resembling ochronosis have not been previously described.


OBJECTIVE
The purpose of this study is to report a series of 5 patients with localized argyria with the histologic feature of "pseudo-ochronosis." In one patient, biopsy was performed on 2 distinct lesions.


METHODS
All patients underwent skin biopsies for light microscopy and darkfield microscopy. In two patients, the biopsy specimens were analyzed with a mass spectrophotometer; scanning electron microscopy and energy-dispersive x-ray analysis were performed. In one patient, the biopsy specimen was decolorized with 1% potassium ferricyanide in 20% sodium thiosulfate.


RESULTS
All 5 patients presented with the typical clinical and histologic features of localized argyria. Ochre swollen and homogenized collagen bundles were seen in all cases. In addition, light microscopy in 4 cases revealed an ellipsoid black globule within a zone of collagen degeneration.


CONCLUSIONS
The histologic features of localized argyria include swollen and homogenized collagen bundles resembling ochronosis, "pseudo-ochronosis," which may be more common than previously recognized.
Robinson-Bostom
Leslie
L
Department of Dermatology, Brown University School of Medicine/Rhode Island Hospital, Providence, RI 02903, USA. Lrobinson-bostom@Lifespan.org
Pomerantz
David
D
Wilkel
Caroline
C
Mader
Russell
R
Lerner
Lisa
L
Dufresne
Raymond
R
Flotte
Thomas
T
D000368:Aged; D001129:Argyria / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D001707:Biopsy, Needle; D046508:Culture Techniques; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D009794:Ochronosis / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D011379:Prognosis; D012680:Sensitivity and Specificity; D012867:Skin / Q000473:pathology*