Pediatric Emergency Medicine

Case Study of the Month- May

Submitted by: Robert Felter, MD
Children’s National Medical Center
Edited by: Mohsen Saidinejad, MD, MBA

A 3-year-old male was brought to the ED because of his mother’s concerns about changes in his fingernails. The child had been well with the exception of symptoms of upper respiratory infection (URI) and a generalized rash 6 weeks prior to visit. The rash had been on both hands and feet as well as circumoral and in the groin. The patient was evaluated at that time by his primary care provider and a diagnosis of hand, foot, and, mouth disease was made. The URI symptoms and rash both resolved in one week. Patient’s mother noted a new discoloration at the base of the nails one week ago and the nails began to chip and fall off. The only reported treatment given at home was hydrocortisone cream on the hands due to severe eczema.

May case image
The nail findings are most likely due which of the following?



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