An 84-year-old male with a history of diabetes mellitus type 2, prostate cancer and congestive heart failure was admitted for lower extremities cellulitis. His skin examination revealed localized green pigmentation of the palmar surface of the left hand (Figure 1). The patient had been injured during the Second World War and had metal fillings, probably lead fragments, embedded in his skin since then. This type of skin discoloration caused by direct implantation of bullet lead residues is permanent but benign, because lead fragments in soft tissue usually become encapsulated with fibrous tissue and do not cause problems. Lead poisoning has been reported after intra-articular implantation of lead bullet fragments.1 Our patient did not present any symptoms of lead intoxication besides his skin green pigmentation.
Figure 1.
Greenish discoloration over thenar area due to embedded lead fragments (for a full colour image please see the online version of this article).
Funding
National Institutes of Health (3P30CA023100-25S8 to S.K.).
Conflict of interest: None declared.
Reference
- 1.Hollerman JJ, Fackler ML. Wound ballistics. In: Tintinalli JE, Kelen GD, Stapczynski JS, editors. Emergeny Medicine: A Comprehensive Study Guide. 6th. McGraw-Hill; 2004. pp. 1633–9. [Google Scholar]