Fungal Nail...? Black Stripes

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36 y.o. female presented to clinic with bilateral presentation of medial and lateral black lines on nail and in sulcus on her halluxes.....her sister has the same and mother has one black line running down the middle of her nail...all were treated for a GI infection 4-5 months ago...remnants of the infection I suppose....their physician treated them for a candida infection....but I thought that this time of presentation was more suited to a psedomonas infection.....one other puzzling aspect that lead to a possible DDx of Addisons disease (before I foundout about mother and sister) was that each patient experienced temporary blackening of the skin on several sites of their body...mostly in the knees - where there is likely a lot of scar tissue - thus a supporting aspect for Addisions...or other related pathology....

 

any images? possible aspergillus?

 

yes that is what i would have thought.....here is image (not a great one though)

http://img39.imageshack.us/i/004dnj.jpg/

 

Hi CFG,

Interesting case. A little more info would be spiffing. Did all 3 (her sister, mother and self) manifest symptoms at the same time? Did they all run a marathon? Is there any history of familial systemic pathology, such as Darier disease?

Nice pic, but is it possible to obtain some more of all the nails? And of the other family members? From the one provided, I would suggest that the sulci and PNF and matrix areas appear to be traumatised. However, it is good practice to look at diff dx of discoloured longitudinal lines.

Longitudinal brown lines in the nail plate form because of increased melanin produced by nail matrix melanocytes. These can be associated with:

Addison's disease;
Nevus at the nail base;
metastasis (secondary cancer);
Melanoma;
and Trauma.

Cheers,
Bel

 

What ethnic group is she from I have seen something like this (image is limited) in several patients with Asian and afarican heritage

 

peruvian

 

patient had a baby 2.5 years ago - her mother and sister and herself ..also all had blackended skin in several spots after their respective pregnancies...they all got sick around the same time 4 -5 months ago with a GI infection which the family physician diagnosed as a candida infection - this is hwne the blackened nails started

 

status update - have not seen patient since - will be coming back in one month