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A young man with orange hands

      A 26-year-old Caucasian man with previous history of medullary sponge kidney (also known as Cacchi-Ricci disease) presented to the outpatient clinic for routine follow-up. While his kidney disease remained uncomplicated, the patient reported the recent orange discoloration of palms and soles. Clinical examination confirmed an orange aspect of palmar skin (Fig. 1), but no change in the color of his sclera. Blood tests including bilirubin, thyroid hormones, glucose, creatinine, and liver enzymes were all normal, and total cholesterol was mildly increased (206 mg/dl, normal <190). Serum β-carotene levels were elevated (722 μg/dl, normal 60–200), while vitamin A (retinol) levels remained within the normal range (66 μg/dl, normal 30–80). Further questioning revealed dietary intake of 15 g of spirulina (in pill form) per day for the last six months, for its potential anti-oxidant effects.
      Fig. 1
      Fig. 1The patient's hand is shown on the right, and the hand of an individual without hypercarotenemia on the left.
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