On wiping the pendant with cotton dipped in spirit, a green stain appeared on the piece of gauze, thus dispelling the doubt and concluding the mystery. On wiping the macule with a wisp of cotton dipped in spirit, the macule disappeared. The copper pendant usually rested on the site where there was a green macule, giving a clue to the puzzle. Incidentally, the patient was observed wearing a pendant made out of copper attached to a thread on his neck. But the patient neither could recollect a history of trauma nor had a bruise or red lesion at that site. Coagulation parameters were within normal limits. Initially green pigmentation was thought to be due to biliverdin following a bruise or subcutaneous bleed related to the pancreatitis. There were no other remarkable examination findings except for the scars on the abdomen due to the prior surgery. On examination, there was a diffuse greenish macular pigmentation of 4 × 4 cm size over the presternal area.
The patient couldn’t recollect any history of trauma inflicted to that site. He was referred by the gastroenterologist suspecting the pigmentation to be related to his medical illness. The patient had undergone laparoscopic cholecystectomy a month back. A 30-year-old gentleman with chronic pancreatitis due to SPINK 1 mutation was referred by gastroenterologist for a green-colored lesion on the presternal area of a month's duration.
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