Painful fingernails in a patient with chronic fibrosing pulmonary aspergillosis

Published: 11 May 2018
Author(s): Anuradha Bishnoi, Ritesh Agarwal, Sanjeev Handa, Inderpaul Singh Sehgal
Issue: June 2018
Section: Internal Medicine Flashcard

A middle aged male, farmer by occupation was diagnosed with chronic fibrosing pulmonary aspergillosis due to Aspergillus flavus. He was started on oral voriconazole (400 mg/day) after he had poor clinicoradiological response to itraconazole. After a month of initiating voriconazole, he presented with bleeding and painful fingernails. Examination revealed tender separation of distal nail plates from nail bed (onycholysis) with hemorrhagic blisters beneath, in multiple fingernails (Fig. 1a). Onycholysis was crescentic with well-defined proximal erythematous rim that was concave distally (Fig.