January 1997

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

Author Affiliations

Departments of Pediatrics and Psychiatry National Jewish Center for Immunology and Respiratory Medicine and University of Colorado Health Sciences Center 1400 Jackson St Denver, CO 80206

Arch Pediatr Adolesc Med. 1997;151(1):103-105. doi:10.1001/archpedi.1997.02170380107021

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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