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Chronic Subungual Hematomas: A Presumed Immunologic Puzzle Resolved With a Diagnosis of Child Abuse

Leslie A. Gavin, PhD; Miguel J. Lanz, MD; Donald Y. M. Leung, MD, PhD; Thomas A. Roesler, MD
Arch Pediatr Adolesc Med. 1997;151(1):103-105. doi:10.1001/archpedi.1997.02170380107021.
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Bleeding under the fingernails is most often the result of trauma, especially in toddlers. When no history of trauma can be elicited from responsible parents, and the presentation of subungual hematomas is dramatic and persistent, the result is a diagnostic challenge.

Patient Report. A 2-year-old boy was referred to the National Jewish Center for Immunology and Respiratory Medicine (NJCIRM) Denver, Colo, for an immunologic workup for recurrent chronic subungual hematomas, hand swelling, and presumed resistant candidiasis.

Subungual hematomas, edema, and nailbed peeling on both hands at admission.

His initial symptoms of redness and swelling of several fingernail beds and subungual bleeding occurred at age 19 months. Cellulitis was diagnosed by his pediatrician, and the boy was started on cefadroxil (Duricef) therapy. One month later, he was seen again for continued fingernail symptoms. The child was referred to a dermatologist who documented multiple subungual hematomas of most fingernails and both great


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