Home            Past Issues            About IP            About IAP           Author Information            Subscription            Advertisement              Search  

   
images

Indian Pediatr 2009;46: 728

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]
 

 


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.

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.
 

 

Copyright© 1999 by the Indian Pediatrics (Disclaimer)