Pseudocyanotic pigmentation of the skin induced by amiodarone: a light and electron microscopic study

An unusual bluish discolouration of the nose was noticed in a woman 9 months after she had begun treatment with a coronary vasodilator, amiodarone hydrochloride. Cutaneous biopsies of the nose were obtained 6 and 9 months later for light and electron microscopic studies. In the dermis were histiocytes containing cytoplasmic yellow-brown granules with histochemical properties of melanin and lipofuscin. Ultrastructurally the granules appeared as lysosomal membrane-bound dense bodies similar to lipofuscin. Similar granules were observed at diascopy in both corneas. The pathogenesis is obscure. A storage disease involving the drug or its metabolites cannot be ruled out. Another possibility is that amiodarone accelerates the normal cellular autophagocytosis, resulting in increased production of lipofuscin, which then accumulates in lysosomes because of a deficiency in lipolytic enzymes.