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Indian Pediatr 2009;46: 728 |
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Nail Changes in Langerhans Cell Histiocytosis |
Tapas Kumar Sabui,
Radheshyam Purkait, Department of Pediatric Medicine,
NRS Medical College and Hospital, 138,
AJC Bose Road, Kolkata 700 014.
Email: [email protected]
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A 3 year-old female patient presented with complaints of fever, nausea,
vomiting and jaundice for 2 months. On examination, anemia, cholestatic
jaundice, grade I clubbing, remarkable hepato-splenomegaly and generalized
lymph node enlargement were observed. She developed progressive changes of
nails of hands and feet over the next three weeks. Nail changes were
characterized by subungual tissue proliferation, hyperkeratosis, erosions
of nails and cheesy yellowish discharge from nail beds (Fig. 1).
The discharge material was sterile in nature. Culture of nail clippings
was negative for fungi. Langerhans cell histiocytosis (LCH) was confirmed
by lymph node biopsy.
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Fig.1. Nail changes showing subungual
cheesy collection, hyperkeratosis and onycholysis. |
Although the nail changes were very characteristic but
not diagnostic, they were missed initially because of its rarity. The
differential diagnosis includes pachyonychia congenital, dyskeratosis
congenital, onychomycosis, psoriasis and chronic mucocutaneous candidiasis
or Darier disease. In these cases, however, the constellation of typical
clinical findings is a clue for diagnosis.
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