This young man has HCV+ with Focal Sclerosing Glomerulonephritis and is an ex-IVDU.
This is the picture of his hand:
Question:
1. What is the finding and what is its significance?
Mon, 120508 @ 0700
12
May
08
Jimbo's been hit
- 598,399 times
Jimbo on Twitter
- jimbo blogged about case #84: http://tinyurl.com/o3nwhr 7 hours ago
- 10 burning questions on Transformers 2 but when again, after watching Megan Fox, who needs logic? http://tinyurl.com/mut6my 3 days ago
- Jimbo blogged about toilets and STD: http://tinyurl.com/nmhl4n 3 days ago
- Jimbo blogged about the Sem 3 OSCE: http://tinyurl.com/kq8vh8 5 days ago
Mountain Climbing dates, 2009
25 July 2009 - Gunung Datuk/ 18 July 2009 - Gunung Nuang
Influenza A H1N1 Update
The Buzz
- CK on CAse #84: The elderly woman who fell
- ren on CAse #84: The elderly woman who fell
- Harlequin on 1.1 decade
- aisyahuh on Toilet Tale
- Harlequin on CAse #84: The elderly woman who fell
- Jimbo on Case #82: The man with itchy skin
- oyy on 1.1 decade
- Jimbo on 1.1 decade
- Medicalstudent on 1.1 decade
- Jimbo on Lunch with VIPs
Top Posts
Recent Posts
Blog Rounds
Fellow Bloggers
- Abby’s Mummy
- Chee Koon
- Cytusm
- dobbs@home
- Edina Monsoon
- Eunice Tan
- Eve Leng Leng
- Fibrate
- Harapan Malaysia
- Haris Abdul Rahman
- HIV/ID Rounds
- Jing Tzer
- Jonzz
- Ken Lui
- Kok Hon
- Las Montanas
- Mob’s Crib
- OYY
- Patrick Teoh
- Product of the System
- Sakthi’s thoughts
- Sbanboy
- Speckie’s Weblog
- Syafiq
- Terence
- TFTD
- The People’s Parliament
- Vagus
- Yenjai
- Yew TW
I listen to
I support
What Jimbo writes about:
Top Kudos Holders (updated till Case #80)
ck 44
oyy 36
tftd 34
peanut 30
dytia 27
fengy 26
w1 16
nila 14
yumei 12
cheekoon 8
jing 8
AM 7
farah 7
chiet 7
lishun 6
AL 6
syafiq 6
vagus 6
SE 5
Old issues
Free Dr. Basmullah, Repeal the PHFSA!
But…the CSI-work must fail: Muehrcke´s lines do not move with the nail growth, actually they are located underneath the nail plate.
tank yu tank yu for posting
Answers today:
First of all I have to apologise to my students when I told them the nail changes were Beau’s line when I took the CP earlier. It’s my oversight. The scenario reminded me of what dr.raindeer wrote about above!
The correct diagnosis of course is Muerchke’s lines.The differential diagnosis would be Beau’s lines which, most of you mentioned, correctly, resembles the former except that the latter is GROOVED!
The best answer came from CK. The clue of course is hypoalbuminemia secondary to FSGS which commonly presents as Nephrotic Syndrome . The cause of FSGS was most probably associated with his HCV status.
dr.raindeer gave a good description of how to do a bit of medical CSI because by estimating the length of the lines, one could guess when a patient had an episode of hypoalbuminemia or stress causing relative malnutrition. In this case, the man had a history suggestive of nephrotic syndrome about 1.5 months prior to this admission. It takes about 3 months for finger nails to grow from the proximal to the distal end.
yuying gave a good list of nail changes names and their causes.
The kudos this time goes to: CK, peanut, DoonYk, yuying, FiQ, HsMcD and dr.raindeer.
Well done.
Thank you for taking part. More spot diagnosis coming over the next 3 weeks!
hmm…interesting….i’ve seen this before…n i’ve argued with my consultant (after seeing a case in the med ward with similar history in UK) that it’s muehrcke’s lines…n he insisted that it was beau’s line indicative of previous insults (i.e infection, malnutrition, severe illness, chemo, etc), which eventually correlates with the patient’s past hx previously. Finger nail grows at the rate of o.1 mm a day…so u basically can calculate the actual time the “insult” happened.
The funny part is…i said…in beau’s line, there has to be palpable indentation…unlike in muerchke’s which is not. N , he still insisted on his dx!! grrrr…. Anyway…cant say more.. so, im betting on BEAU’s line..n may be, he could be rite..u never know.. It’s all thru experience, i guess.
DESCRIPTION of the pic : bilateral tranverse white bands seen on the fingernails.
d/d : muerchke’s lines ..indicative of hypoalbuminaemia..
yumei, don’t be too hard on yourself.
horizontal transverse white lines in nails = leuchonychia = chronic liver disease 2o to chronic hep c
vasculitic change 2o to septic emboli?
i feel so stupid :/
Aihhhh~~why~~(same feeling like peanut haha…)
I would geuss it’s Muehrcke’s lines, or leukonychia striata.
They are white lines appearing like half moon and they are not grooved (so, rule out of Beau’s lines)
FSGN causes nephrotic syndrome. Hypoalbuminaemia…um…suits with Muehrcke’s line :p
Transverse leukonychia – Muehrcke’s lines, secondary to hypoalbuminaemia
Some say it is alternating with transverse melanochia. How ar doc?
for this kind of spot diagnosis.. .it is often confusing…so many lines..
Terry’s (white) nails indicates Hepatic failure, cirrhosis, diabetes mellitus, CHF, hyperthyroidism, malnutrition
Muehrcke’s lines is Specific for hypoalbuminemia
Mees’ lines indicate Arsenic poisoning, Hodgkin’s disease, CHF, leprosy, malaria, chemotherapy, carbon monoxide poisoning, other systemic insults
Beau’s line less likely..cuz it’s mainly nail furrowing.
From the history: HCV+, FSGN, ex-IVDU…
HCV+ so? liver cirrhosis cant be manisfested so fast at young age..IVDU is common to have HCV+. Dunno why….
FSGN… erm.. this one why le? wat cause the GN? emboli? immune complex? HIV?
wat FSGN can present with? usally nephrotic syndrome… protein lost.. hypoalbuminemia
so, Muehrcke’s lines is Specific for hypoalbuminemia
tembak Muehrcke’s line la…
Muehrcke’s lines : indicate hypoglobuminaemia.
ah.. ck is always one step faster than me.. -_-’ thought it would be so good to give a different opinion..
I think it is Muehrcke’s lines as well.. it happens when there is a loss of albumin. It fits better with the history provided as a clue (focal sclerosing glomerulonephritis).
Findings
1)Muehrcke’s lines noted on all the nails. 2 transverse parallel lines to the lunula are seen in the picture separated by a band of pink. The fingers are also noted to be reddish in colour (Maybe due to increased vascularity). There seems to be finger clubbing & a lateral view of the nail is required to confirm it or Schamroth’s sign (diamond aperture seen while apposing fingers) to be done.
2)The lines are non-specific findings due to metabolic stress. In correlating to the HCV & FSGS status of the patient, the lines are suggestive of hypoalbuminemia (possibly due to albuminuria in urine due to FSGS or liver cirrhosis impairing liver function) or chemotherapy due to cancer of the liver (Hepatitis C liver status). The patient needs to be monitored for his liver & kidney functions.
the terry nails is due to decrease in vascularity and an increase in connective tissue within the nail bed. It has a white ground glass apprearance and it’s often seen in liver diseases. Erythema due to vasculitis???!!?!??!! hohoho..merely tembak~
1.Erythema of Fingers
2.Terry’s nails
Terry’s nails seen in cirrhosis and chronic renal failure