Ochronosis from Quinacrine (Atabrine)

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Abstract
The development of ochronosis in a 46-year-old man as a result of prolonged ingestion of quinacrine (Atabrine) is described. Blue-black pigmentation appeared first in the hard palate, then in the nail beds, helix of the ear, infra-orbital areas, alae nasi, and sclerae. Symptoms of degenerative arthritis appeared at an earlier age than usual, and these are at present accompanied by roentgenographic signs involving especially the lumbar spine. In addition, the patient developed symptoms and signs of peripheral nerve involvement either as a result of nerve root involvement due to the degenerative disease of the spine or as a chemical toxic effect of quinacrine. Alcaptonuria was excluded by appropriate biochemical tests and a negative family history. Possible mechanisms of pigment formation and production of degenerative arthritis are discussed. Since the syndrome produced as a result of prolonged quinacrine ingestion resembles alcaptonuric ochronosis with regard to its clinical manifestations, even including early degenerative arthritis, it warrants inclusion as a further example of phenocopy in human genetics. There has been a gradual decrease in the intensity of the pig-mentation and some improvement in the peripheral neuritis during a 10 month period in which the patient refrained from ingesting quinacrine.