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When one is confronted with a case of diabetes, enlarged liver, palpable spleen and ashy gray color of the skin the presumptive evidence is that one is dealing with a case of hemochromatosis. To prove this one can perform a biopsy of the skin, and if this shows the pigment the diagnosis is settled.
In the case I am reporting there were severe diabetes, an enlarged liver, a palpable spleen and an ashy gray color. A biopsy of the skin showed no pigmentation. Clinically the condition was hemochromatosis, but the lack of pigment in the skin raised a question. The patient was a man aged 42 who had diabetes of a year's standing. He had always been dark but more so in recent years. His brother was dark skinned but had no diabetes. His general health was always excellent until April 1937, when he began to lose weight, and at
John HJ. HEMOCHROMATOSIS WITHOUT PIGMENTATION OF SKIN: RESISTANCE TO PROTAMINE ZINC INSULIN. JAMA. 1939;112(22):2272–2273. doi:10.1001/jama.1939.62800220002010a
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