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Non-Invasive Visualization of Nailbed Microvascular Morphology in Mice Using Capillaroscopy

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[Nail abnormalities revealing AL systemic amyloidosis].

M Étienne¹, N Denizon², H Maillard¹

¹Service de dermatologie, centre hospitalier du Mans, 194, avenue Rubillard, 72037 Le Mans cedex 9, France.

La Revue De Medecine Interne

|March 12, 2014

Summary

Systemic amyloidosis AL, a rare condition, can manifest through unusual nail abnormalities. This case highlights how nail changes can be the primary indicator of this serious systemic disease.

Keywords:

AL amyloidosis Amylose systémique Anomalies unguéales Multiple myeloma Myélome multiple Nail abnormalities

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Area of Science:

Dermatology
Hematology
Internal Medicine

Background:

Systemic amyloidosis frequently involves mucocutaneous sites (29-40%), with purpura and macroglossia being common.
Nail involvement is an infrequently observed manifestation of systemic amyloidosis.

Observation:

A 76-year-old male presented with several months of nail lesions, including subungual hyperkeratosis, distal onycholysis, and splinter hemorrhages.
A subtle purpuric eyelid erythema was noted but initially overlooked.
Diagnostic work-up confirmed systemic amyloidosis associated with lambda light chain multiple myeloma.

Findings:

Nail abnormalities are rarely described in systemic amyloidosis AL.
These nail changes can present in various forms and may be the sole cutaneous sign.
Skin biopsy of the nail matrix can aid diagnosis but carries a risk of subsequent onychodystrophy.

Implications:

Nail abnormalities can serve as an early diagnostic clue for systemic amyloidosis AL.
Labial salivary gland biopsy is suggested as the most sensitive diagnostic method.
Early recognition of cutaneous manifestations is crucial for timely diagnosis and management of systemic amyloidosis.