title: [Apomorphine hyperpigmentation].
abstract: A 72 year old bedridden, disoriented man presented with a continuously increasing number of blue nodules on his abdomen and both thighs. In addition, he had a melanoma on his left forearm (SSM, Clark level III, Breslow 0.75 mm), which lead to the clinical diagnosis of melanoma metastases. Biopsy of one of the blue nodules showed CD68 positive histiocytic cells loaded with brownish pigment granules and a lymphocytic infiltrate within the deep dermis and upper subcutis. The pigment reacted histochemically similarly to melanin. Melanocytes were absent at these sites. Because of the unexplained clinical and histopathological picture, the patient's history was reassessed and it was learned that the patient had received subcutaneous infusions of apomorphine for the past 10 years for the treatment of Parkinson's disease. By oxidation, apomorphine may be converted into tetrahydroisoquinoline-melanin, which apparently is the cause for the accumulation of pigment within the deep dermis.
authors.affiliation: Universitätsklinik für Dermatologie, Abteilung Allgemeine Dermatologie, Universität Wien, Vienna, Austria..
authors.forename: R
authors.initials: R
authors.lastname: Loewe
authors.forename: M
authors.initials: M
authors.lastname: Püspök-Schwarz
authors.forename: P
authors.initials: P
authors.lastname: Petzelbauer
mesh_terms: D036541:ADP-ribosyl Cyclase / Q000378:metabolism; D051997:ADP-ribosyl Cyclase 1; D000368:Aged; D015703:Antigens, CD / Q000378:metabolism; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D001058:Apomorphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced* / Q000473:pathology; D007279:Injections, Subcutaneous; D007801:Langerhans Cells / Q000473:pathology; D008297:Male; D008543:Melanins / Q000378:metabolism; D008544:Melanocytes / Q000473:pathology; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology; D008562:Membrane Glycoproteins; D010084:Oxidation-Reduction; D010300:Parkinson Disease / Q000188:drug therapy*; D012867:Skin / Q000473:pathology
chemical_list: D015703:Antigens, CD; D000978:Antiparkinson Agents; D008543:Melanins; D008562:Membrane Glycoproteins; D036541:ADP-ribosyl Cyclase; C498154:CD38 protein, human; D051997:ADP-ribosyl Cyclase 1; D001058:Apomorphine