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Brown nails as clues for shock diagnosis
Satoshi Inaba1,2, Hisatoshi Okumura3, Yuichiro Nakanishi4
1Department of General Internal Medicine Fukuchiyama City Hospital Fukuchiyama Japan.
Journal of General and Family Medicine
|March 10, 2025
Summary
Brown nail discoloration in a farmer led to the diagnosis of tuberculous Addison's disease. Early recognition of this adrenal insufficiency symptom enabled prompt treatment and recovery.
Area of Science:
- Endocrinology
- Infectious Diseases
- Dermatology
Background:
- Adrenal insufficiency, or Addison's disease, can present with non-specific symptoms.
- Nail hyperpigmentation is an uncommon but potential indicator of adrenal insufficiency.
Purpose of the Study:
- To highlight the diagnostic significance of nail hyperpigmentation in adrenal insufficiency.
- To report a case of tuberculous Addison's disease presenting with shock and nail discoloration.
Main Methods:
- Case report of a 60-year-old male farmer.
- Clinical presentation: shock unresponsive to fluids.
- Diagnostic confirmation: elevated ACTH levels and incidental observation of brown nail discoloration.
Main Results:
- The patient presented with shock and was initially unresponsive to fluid resuscitation.
- Brown nail discoloration was observed, prompting suspicion of adrenal insufficiency.
- Elevated ACTH levels confirmed adrenal insufficiency, leading to the diagnosis of tuberculous Addison's disease.
Conclusions:
- Nail hyperpigmentation can be a crucial diagnostic clue for adrenal insufficiency.
- Early identification of tuberculous Addison's disease through subtle signs like nail changes is vital for effective management.
- Prompt diagnosis and treatment led to the resolution of the patient's condition.
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