Nail changes as the first sign of systemic amyloidosis

A 68-year-old man had had for 3 years a severe onychodystrophy involving all fingers and toes which clinically mimicked nail lichen planus. The nail biopsy showed amyloid deposits in the superficial dermis of the nail matrix. Physical, pathological and laboratory examinations confirmed the diagnosis of primary systemic amyloidosis. At the time of the diagnosis the patient did not present any other cutaneous sign of systemic amyloidosis.