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. 2025 Jul 2;20:333. doi: 10.1186/s13023-025-03860-8

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© The Author(s) 2025

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — Clinical photographs of the patient showing (A) flaky skin with blood crusts on the lips and mouth, (B) slightly thickened skin on the finger joints and some lesions with blood crust formation, (C) liver biopsy tissue strip, (D) liver histopathology (H&E stain, 400×) showing pigment in Kupffer cells with birefringent crystals called “Maltese cross” configuration, (E) immunofluorescence of erythrocytes