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Internal Medicine: Open Access
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Peculiar Nail Lesions in a 25 Year Old Man

Malek A1*, Nasnas PE2 and Nasnas R1

1Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Hotel Dieu De France Hospital, Beirut, Lebanon

2Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon

*Corresponding Author:
Alexandre Malek
Department of Infectious Diseases, Faculty of Medicine
Saint Joseph University, Hotel Dieu De France Hospital, Beirut, Lebanon
Tel: +961 70736237
E-mail: alexandermalek@hotmail.com

Received date: April 30, 2017; Accepted date: May 04, 2017; Published date: May 08, 2017

Citation: Malek A, Nasnas PE, Nasnas R (2017) Peculiar Nail Lesions in a 25 Year Old Man. Intern Med 7:i116. doi:10.4172/2165-8048.1000i116

Copyright: © 2016 Mbamalu ON, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

A 25 year-old man presented to the emergency department with one month history of severe, unusual nail lesions preceded by mouth ulceration (Figure 1). The physical examination revealed periungual blisters, inflammation and edema of the proximal, lateral and posterior nails folds of all fingernails and toenails (Figures 2 and 3). We noticed several flaccid skin bullae on his back (Figure 1). The patient was otherwise healthy. He worked in Africa for 2 years duration.

Clinical Image

A 25 year-old man presented to the emergency department with one month history of severe, unusual nail lesions preceded by mouth ulceration (Figure 1). The physical examination revealed periungual blisters, inflammation and edema of the proximal, lateral and posterior nails folds of all fingernails and toenails (Figures 2 and 3). We noticed several flaccid skin bullae on his back (Figure 1). The patient was otherwise healthy. He worked in Africa for 2 years duration.

internal-medicine-Severity-Mouth-ulcerations

Figure 1: A: Mouth ulcerations. B: Bullous cutaneous lesions on the back.

internal-medicine-Severity-Left-fingernails-lesions

Figure 2: A: Right fingernails lesions. B: Left fingernails lesions.

internal-medicine-Severity-Toenails-lesions

Figure 3: Toenails lesions.

He received before admission an antifungal and antibiotics treatment without improvement. Skin biopsy showed acantholytic intraepidermal bullae and direct Immunofluorescence disclosed intercellular deposition of IgG and C3 in favour of Pemphigus vulgaris. Initially, He was treated by systemic corticosteroids and adjuvant immunosuppressant Azathioprine 50 mg TID that resulting in partial clinical response then relapse of the disease upon tapering of steroids. We obtained a spectacular and effective clinical resolution of mucocutaneous and nail lesions with no permanent damage on the nails (Figure 4) after two cycle of Rituximab 1 g intravenously separated by 2 weeks.

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