Clinical Images
Blue Man Syndrome
A 74-year-old man presented for a “summer tan” that never faded. Over the previous two months, his face and arms progressively turned from brown to blue-grey, and he developed brown urine. He denied ingestion of silver products or environmental exposures. His exam was significant for slate-grey coloration of the face and arms with
sparing of the torso and legs. Testing for methemoglobin, silver, ceruloplasmin, copper, ferritin, and cortisol was within normal limits. A bladder wash demonstrated pigment laden macrophages without malignant cells. Imaging showed bladder, hepatic, adrenal, subcutaneous and intracranial nodules.
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References:
1. Sebaratnam, “Diffuse melanosis cutis: A systematic review of the literature” J Am Acad Dermatol 2012.
Author Bio:
Kristy Mathes MD is currently a third year internal medicine resident at Oregon Health and Science University in Portland, Oregon.