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Related Experiment Videos

Persistent cutaneous pseudolymphoma after intradermal gold injection

K Kalimo1, L Räsänen, H Aho

  • 1Department of Dermatology, University of Turku, Finland.

Journal of Cutaneous Pathology
|August 1, 1996
PubMed
Summary

Gold sodium thiomalate (GSTM) injections caused persistent skin papules in patients. Histology revealed pseudolymphoma with gold accumulation in macrophages, indicating constant immune activation.

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Area of Science:

  • Dermatology
  • Immunology
  • Histopathology

Background:

  • Gold sodium thiomalate (GSTM) is used in treating rheumatoid arthritis.
  • Cutaneous reactions to GSTM can occur, but their underlying mechanisms are not fully understood.

Purpose of the Study:

  • To investigate the histological and ultrastructural features of skin lesions developed after intradermal GSTM testing.
  • To determine the role of gold accumulation in the pathogenesis of these lesions.

Main Methods:

  • Intradermal skin testing with GSTM in patients.
  • Surgical excision and histological examination of resulting skin papules.
  • Immunohistochemical staining for various cell markers (ACPI, CD68, factor XIIIa, S-100).
  • Electron microscopy and X-ray microanalysis for gold detection.

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  • Atomic absorption spectrophotometry for gold quantification.

    • Main Results:

    • Five out of eight patients developed persistent skin papules at GSTM test sites.
    • Histology showed pseudolymphoma with B and T cell infiltration, follicular structures, and granulomas.
    • Macrophages were prominent, containing crystalloid material with gold, confirmed by X-ray microanalysis and spectrophotometry.
    • Immunohistochemistry identified ACPI-positive follicular dendritic cells, CD68-positive macrophages, and S-100 positive cells.

    Conclusions:

    • GSTM accumulates in tissue macrophages, leading to persistent immune activation.
    • This accumulation triggers lymphoid proliferation and a significant histiocytic response, manifesting as pseudolymphoma.
    • The findings elucidate a mechanism for chronic cutaneous reactions to gold compounds.