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Unusual and memorable

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This 58 year old woman has a history of seropositive rheumatoid arthritis for 25 years. Her disease was controlled with 50 mg sodium aurothiomalate every three weeks for the past 21 years. Recently she had noticed a change in her skin colour.

 On examination she had slate grey pigmentation over her face, neck, and hands, most marked in the periorbital region. There was no history of amiodarone ingestion. There was no history of respiratory disease and arterial blood gases were normal. She did not have haemochromatosis.

 Chrysiasis secondary to longstanding sodium aurothiomalate treatment was first described in 1928.1 It is a photodependent pigmentation resulting from aurosomes gathering in light exposed regions.

 The phenomenon is dose dependent, the severe form being reported after a cumulative dose of 263 mg/kg of sodium aurothiomalate.2 This woman had a cumulative dose of 787 mg/kg. It is a benign condition but has a high potential for misdiagnosis if unrecognised.

Acknowledgments

Contributors: sinead m langan, claire harrison, gary d wright.Department of Rheumatology, Royal Victoria Hospital, Belfast.

References

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