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JAMA Dermatology Clinicopathological Challenge
November 2013

Green Pigmentation on the Palms and Soles

Author Affiliations
  • 1Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
JAMA Dermatol. 2013;149(11):1339-1340. doi:10.1001/jamadermatol.2013.4299

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.