INTRODUCTION
SARS-CoV-2 infection has been associated with a variety of changes in the nail unit,1 namely nail fold capillary changes,2 pernio-like changes known as COVID-toes or COVID-fingers3-5 positive for SARS-CoV-2 in 50% of patients6,7 acral gangrene,8 Beau’s lines,9-11 which may be associated with leukonychia,9 onychomadesis,12 periungual desquamation similar to that observed in Kawasaki Syndrome,13 transverse leukonychia,9,14 erythronychia characterized by erythema just distal to the lunula (the red half-moon sign),15,16 distal orange discoloration,17 a heterogeneous red–white discoloration of the nail bed with distal onycholysis,18 and brittle nails.19
In 1985, Shelley and Shelley described a transverse discontinuity and transverse band of leukonychia in all nail plates in a patient with a sudden onset drug-induced erythroderma and designated this change as shoreline nails.20 The defective keratinization occurred in the nail matrix. To date, this same nail presentation has also been associated with type 2 lepra reaction21 and has not been associated with SARS-CoV-2 infection.
In 1985, Shelley and Shelley described a transverse discontinuity and transverse band of leukonychia in all nail plates in a patient with a sudden onset drug-induced erythroderma and designated this change as shoreline nails.20 The defective keratinization occurred in the nail matrix. To date, this same nail presentation has also been associated with type 2 lepra reaction21 and has not been associated with SARS-CoV-2 infection.
CASE REPORT
A 71-year-old patient with arterial hypertension and hyperuricemia treated with valsartan and allopurinol was seen in consultation for a nail dystrophy in November 2020. Both thumb nails presented with the sudden onset of a transverse groove with leukonychia with what in the skin would be called trailing scale and a more proximal transverse lamellar change resembling onychoschizia as shown in Figure 1. Toenails were unremarkable. History revealed a severe cough with intermittent fever that had begun less than one month before presentation. Nail dystrophy had appeared suddenly one week after the onset of the cough and fever. Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing was positive for SARS-CoV-2 infection. Symptoms disappeared within two weeks without severe respiratory sequelae. Only paracetamol was prescribed during this episode. There was no evidence of peripheral vascular disease, Raynaud syndrome nor chilblain. Past medical history was significant for a somewhat violaceous polygonal papular rash on the chest clinically consistent with lichen planus several
