Bevacizumab-induced subungual hemorrhage.

Area of Science:

• Ophthalmology
• Oncology
• Dermatology

Background:

• Exudative (wet) age-related macular degeneration (AMD) is a leading cause of vision loss.
• Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, is an effective treatment for wet AMD.
• Known skin-related side effects of bevacizumab include rash, mucosal hemorrhage, and hemorrhagic ulcers.

Observation:

• A 71-year-old female patient receiving intravitreal bevacizumab for bilateral AMD developed fingernail discoloration resembling bruising.
• This subungual hemorrhage occurred during six months of continuous bevacizumab therapy.
• No prior reports link bevacizumab directly to subungual hemorrhage exist.

Findings:

• The patient's subungual hemorrhage is hypothesized to be an adverse effect of bevacizumab therapy.
• This finding suggests that subungual hemorrhage may be an underreported side effect of bevacizumab.
• The mechanism may be related to bevacizumab's anti-VEGF activity, similar to other agents.

Implications:

• Clinicians should be aware of the potential for bevacizumab-induced subungual hemorrhage in patients undergoing treatment for AMD.
• Further investigation is warranted to confirm this association and elucidate the underlying mechanisms.
• Monitoring for dermatological side effects, including nail changes, is crucial during bevacizumab therapy.