Occupational Localized Cutaneous Argyria With Pseudo-Ochronosis in a Jeweler

Abstract

A case of localized argyria in a 36-year-old female jeweler is described who presented with 2 discrete and asymptomatic bluish-black pigmented macules on the pulp of her left middle finger. A skin biopsy from both lesions demonstrated deposition of brown/black pigmented granules along the basement membrane zone of eccrine glands, blood vessels, nerves, and the dermo-epidermal junction fully in keeping with silver deposition. In addition, there was yellow-brown deposition seen within the interstitial dermis mimicking an early form of ochronosis, so called "pseudo-ochronosis." This latter feature is rarely described in cases of argyria. Transmission electron microscopy and energy dispersive x-ray spectroscopy confirmed the presence of electron dense particles up to 150 nm in diameter and the presence of silver, respectively. On further questioning, the patient had a history of localized and chronic exposure to silver, which specifically involved holding and manipulating silver wires and rings over the left middle finger. This case highlights an unusual and rare presentation of localized argyria in a jeweler. In addition, our case showed preferential silver deposition on dermal elastic fibers which has not been previously described in the literature.

Localized argyria with pseudo‐ochronosis: A report of two cases highlighting involvement of elastic fibers

“…However, our patients' biopsy specimens appear similar to figures in a previously reported case 1 and, after closer inspection, these are felt to represent elastic fibers and not homogenized collagen bundles (Leslie Robinson‐Bostom, MD, email communication, September 2022). Other authors have since documented that ochre‐colored elastic fibers are a feature of localized argyria with pseudo‐ochronosis 3,4 . In our second case, there were delicate vertically oriented fibers beneath the epidermis, perhaps similar to the finger‐like projections in the papillary dermis previously reported 1 .…”

“…Much like generalized argyria, localized argyria typically shows silver granules at the edge of eccrine glands, in the walls of blood vessels, and along elastic fibers when viewed microscopically 1 . In rare instances, localized argyria has been reported to have histopathologic findings resembling ochronosis, with yellow‐brown or ochre‐colored swollen and homogenized collagen bundles and ochre‐colored elastic fibers 1–5 . Here we present two cases of localized argyria with histopathologic findings consistent with pseudo‐ochronosis.…”

“…Silver granules appear microscopically as brown or brownish‐black fine granules deposited along the basement membrane zone of eccrine glands. Chrysiasis from prolonged treatment with gold salts can appear similar; however, only in localized argyria have findings of pseudo‐ochronosis been reported 1–5,7 …”

“…Chrysiasis from prolonged treatment with gold salts can appear similar; however, only in localized argyria have findings of pseudo-ochronosis been reported. [1][2][3][4][5]7 Ochronosis, either endogenous due to inherited alkaptonuria or exogenous due to the application of topical hydroquinone, results from the accumulation of homogentisic acid. 3,8 The color "ochre" is variable, with red, yellow, orange, purple, or brown tones, as it is a pigment derived from iron-rich rocks that are ground and manipulated into a pigment powder.…”

“…1 In rare instances, localized argyria has been reported to have histopathologic findings resembling ochronosis, with yellow-brown or ochre-colored swollen and homogenized collagen bundles and ochre-colored elastic fibers. [1][2][3][4][5] Here we present two cases of localized argyria with histopathologic findings consistent with pseudoochronosis.…”