Extraordinary Case Report: PDF OnlyOccupational Localized Cutaneous Argyria With Pseudo-Ochronosis in a JewelerGeorgiadou, Nikki BDS Hons, MFDS RCSEd*; Singh, Sarita MBBS, MD, BSC Hons, FRCP*; Wagner, Bart BSc, FIBMS, IBMS Dip Ult Path†; Goggin, Patricia BSc, MMedSci‡; Katsarma, Effie MD, PhD, FEBOPRAS, FRCS§; Singh, Manuraj MBBS Hons, MRCP, PhD, DipRCPath¶Author Information *Department of Dermatology, Chelsea and Westminster Hospital, London, United Kingdom; †Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom; ‡Biomedical Imaging Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; §Department of Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, United Kingdom; and ¶Department of Dermatopathology, St George's University Hospital, London, United Kingdom. Correspondence: Nikki Georgiadou, BDS Hons MFDS RCSEd, Imperial College of Science Technology and Medicine, Imperial College London, London, Greater London, United Kingdom (e-mail: [email protected]). The authors declare no conflicts of interest. The American Journal of Dermatopathology: February 16, 2021 - Volume - Issue - doi: 10.1097/DAD.0000000000001921 Buy PAP Metrics Abstract A case of localized argyria in a 36-year-old female jeweler is described who presented with 2 discrete and asymptomatic bluish–black pigmented macules on the pulp of her left middle finger. A skin biopsy from both lesions demonstrated deposition of brown/black pigmented granules along the basement membrane zone of eccrine glands, blood vessels, nerves, and the dermo-epidermal junction fully in keeping with silver deposition. In addition, there was yellow–brown deposition seen within the interstitial dermis mimicking an early form of ochronosis, so called “pseudo-ochronosis.” This latter feature is rarely described in cases of argyria. Transmission electron microscopy and energy dispersive x-ray spectroscopy confirmed the presence of electron dense particles up to 150 nm in diameter and the presence of silver, respectively. On further questioning, the patient had a history of localized and chronic exposure to silver, which specifically involved holding and manipulating silver wires and rings over the left middle finger. This case highlights an unusual and rare presentation of localized argyria in a jeweler. In addition, our case showed preferential silver deposition on dermal elastic fibers which has not been previously described in the literature. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.