PERSISTENT CUTANEOUS PSEUDOLYMPHOMA AFTER INTRADERMAL GOLD INJECTION

After intradermal testing with goldsodiumthiomalate (GSTM), 5 out of 8 patients developed skin papules at the test sites, which persisted up to 20 months. The lesions were surgically excised. Histology revealed pseudolymphoma of B and T cell type containing follicular structures and occasional small granulomas. The amount of histiocytic cells among B and T lymphocytes was pronounced, including acid cysteine proteinas e inhibitor (AC-PI) positive follicular dendritic cells, CD68 positive macrophages; factor XIIIa positive dermal dendrocytes and S-100 posit ive cells. By electron microscopy the macrophages contained endosomes loaded with crystalloid material which contained gold in X-ray microan alysis. Atomic absorption spectrophotometry also confirmed the presenc e of-old in one specimen. Thus GSTM seemed to accumulate in tissue mac rophages leading tit constant immunologic activation with lymphoid pro liferation and histiocytic response.