Something is Afoot
For each case, choose the correct answer
For answers, see next issue; for discussion, go to www.mdedge.com/clinicianreviews/picture
Case 1 was originally published in the American Journal of Orthopedics (2013;42[3]:121-124).
Case 2 adapted courtesy of Cutis (2000;66[3]:211-212). Copyright 2017 Frontline Medical Communications Inc.
Case 3 adapted from the Journal of Family Practice (2008;57[5]:321-323).
Case 4 credit: ScienceSource. IMAGE NUMBER: SN0826 LICENSE: RIGHTS MANAGED
Answers to last month’s “Picture This” (Clinician Reviews. 2017;27[6]:43): 1c, 2a, 3d, 4b
2. Following treatment for onychomycosis, this 49-year-old man’s toenails demonstrate inflammation of the medial and lateral nail borders of the hallux and second toes of the left foot. This patient’s diagnosis is
a) Subungual exostosis
b) Primary osteomyelitis of the phalanx
c) Tumors of the nail bed
d) Onychocryptosis
Diagnosis: Onychocryptosis, also known as ingrown toenail, is a rare complication of oral antifungal therapy. As the healthy nail plate advances, it may adhere to the nail bed and cut into the lateral nail folds. In this case, the site of the onychocryptosis corresponded to the proximal clearing of the nail plate. The patient required excision of the nail borders, after which the secondary inflammation resolved. The condition was treated with chemical matrixectomy.
For more information, see “Multiple Onychocryptosis Following Treatment of Onychomycosis With Oral Terbinafine.” Cutis. 2000;66(3):211-212.
