Severe paronychia due to zidovudine-induced neutropenia in a neonate

We describe the case of an HIV-perinatally exposed child who was treated with zidovudine prophylaxis for reduction of perinatal transmission. At 4 weeks of age, he developed severe paronychia of the great toes as a result of Candida albicans and Escherichia coli. At that time, laboratory tests showed anemia and neutropenia. Zidovudine-related hematologic toxicity resolved after completion of the prophylactic regimen and the infant became HIV-antibody negative (seroreverter) at 8 months of age. Paronychia resolved after treatment with oral fluconazole and topical antiseptics but the soft tissue of the nailfold was penetrated by the edge of the nail plate, resulting in the formation of a cutaneous bridge over the nail that resolved by spontaneous necrosis. To our knowledge, this rare complication has not previously been described in an HIV-perinatally exposed child treated with zidovudine.