A man in his 50s presented with abrupt-onset asymptomatic green and brown pigmented lesions on both his palms and soles (Figure, A). He had had progressive jaundice for a month and was recently diagnosed as having advanced intrahepatic cholangiocarcinoma. The cutaneous eruption developed 3 days after a high-grade fever during admission for palliative endoscopic retrograde cholangiopancreatography with metallic stent insertion. The investigation for cause of fever showed influenza A infection. He denied history of contact with any greenish substances on his palms and soles during admission. His sweat was colorless.
Triwongwaranat D, Kasemsarn P, Boonchai W. Green Pigmentation on the Palms and Soles. JAMA Dermatol. 2013;149(11):1339–1340. doi:10.1001/jamadermatol.2013.4299