A 41-year-old patient with hepatolenticular degeneration (Wilson disease), who had been treated for 15 years with penicillamine, developed small white papules at sites of venipuncture in the antecubital fossae and at surgical suture sites. Histologically, these papules showed focal areas of connective tissue degeneration in the dermis, but there was no evidence of inclusion cysts. The changes most likely resulted from the effect of penicillamine on new connective tissue formation at the sites of injury. The patient also developed crinkling of the skin of her face and neck while on the penicillamine regimen, and these changes were attributed, at least in part, to the effects of this drug on connective tissue.
The incidence, clinical features and pathology of nine cases of diverticula of the appendix in Malaysians are reported. The findings are discussed and compared with those previously reported. The pathogenesis of the lesion in eight cases is unknown. The rare association of lumenal obstruction by a carcinoid tumour and diverticulum formation in the appendix is seen in one case.