Intracytoplasmic crystalline inclusions in dermal infiltrating cells of granulomatous contact dermatitis due to gold earrings

Abstract

A case of granulomatous contact dermatitis due to gold earrings for pierced ears was studied ultrastructurally. The patient was a 24-year-old woman, who had reddish brown papules on the earlobes. Patch test using gold sodium thiomalate proved strong positive, with blister formation. Histological observation of the papule showed dense cell infiltration throughout the full thickness of the dermis. Ultrastructurally, dermal infiltrating cells consisted of lymphocytes and histiocytes. Unusual crystalline inclusion bodies were observed in the cytoplasm of these cells. These structures were elliptical, not encapsulated and showed a regular fingerprint-like pattern of parallel lines along the short axis. The width of the lines and their intervals was 12 nm. These findings suggest that continuous contact between gold and dermis may induce inflammation, causing granulomatous changes and the development of crystalline inclusion bodies.