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Green Sweating Spots on Hands and Feet: Unusual Expression of Hyperbilirubinemia
- Alessandro Di Stefani, MD;
- Luca Bianchi, MD;
- Augusto Orlandi, MD; and
- Sergio Chimenti, MD
- From Tor Vergata University, Rome, Italy.
Background: Liver disease may cause cutaneous manifestations, including jaundice, purpurae, diffuse erythema, spider nevi, telangiectasia, atrophy, hyperpigmentation, gynecomastia, thin hair, and white nails.
Objective: To describe a patient with cholestatic hyperbilirubinemia who presented with green discoloration of the hands and feet.
Case Report: A 56-year-old man, hospitalized for recurrent fever, latent jaundice, and epigastric pain, progressively developed macules on his hands and feet. The macules were deep green; were partly coalescing; and were preferentially located on the volar and lateral sides of the fingers, palms, and soles (Figure, A). He also had mild keratoderma in the affected areas. Examination with a hand-held dermatoscope revealed a linear distribution of green-colored pigment along the dermatoglyphic ridges with partial sparing of the furrows (Figure, B). A 3-mm incisional cutaneous biopsy was performed. Histopathologic examination showed a hyperkeratotic scale containing accumulation …
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