Orange–brown chromonychia, a novel finding in Kawasaki disease

Abstract

Kawasaki disease (KD) is one of the commonest vasculitis of childhood, where diagnosis is clinical based on a plethora of signs and symptoms. One of the typical findings is the changes in the extremities including the nail changes. Orange-brown chromonychia is a colour change in the nails which has been observed in some cases of KD. Here, we report a series of 40 patients of KD, where a typical transverse orange-brown discolouration of nails or chromonychia was noted in 29 patients. Though chromonychia is noted in many other rheumatic and nonrheumatic diseases, the typical transverse orange-brown chromonychia observed in KD patients can be included as an additional clinical feature in diagnosis of KD.

Orange‐Brown Chromonychia and Kawasaki Disease: A Possible Novel Association?

“…No clear association between KD and orange‐brown chromonychia or pseudochromonychia has been demonstrated, although sporadic reports in the literature suggest a possible link between these entities . Moreover, in a 2013 case series, Pal and Giri documented transverse orange‐brown chromonychia in 29 of 40 individuals with KD. In their observations, nail pigmentation appeared between 5 and 8 days after the onset of fever and started fading approximately 2 weeks after fever onset, characterizing the subacute phase of KD.…”

L’ongle incarné ou onychocryptose

“…Les ongles en pince peuvent être une modification tardive, secondaire à la maladie de Kawasaki. Ils apparaissent au bout d'un à deux mois pour disparaître spontanément [8]. Plusieurs entités cliniques sont identifiées [1] : hypertrophie congénitale d'un seul ou des deux bourrelets latéraux : les bourrelets hypertrophiés enserrent la tablette unguéale qui est souvent koïlonychique, trop « faible » pour repousser les bourrelets, responsables d'une incarnation disto-latérale (figure 4).…”

Red Chromonychia in Kawasaki Disease

“…[2][3][4][5] Chromonychia has been seen in association with several drugs (particularly chemotherapeutic agents and angiotensin receptor blockers), thermal injury, exposure to elemental iron or nail hardeners and other systemic disorders. 3,5 Red transverse chromonychia in Kawasaki disease was first described in 4 patients by Lindsley in 1992. 4 This was followed by a report of transverse orange-brown chromonychia in 2 patients with Kawasaki disease by Thapa and Pal.…”

“…Use of cellulose membranes during hemodialysis, glucan-containing surgical gauzes and antibacterials like piperacillin-tazobactam and amoxicillin-clavulanate has been reported to increase BDG levels. 3 Infusion of filtered blood products, bacteremia and severe mucositis can also cause false-positive elevations. 3 A recent publication involving critical care patients who had cardiac artery bypass grafting showed elevated BDG levels, speculated to be from the membranes used during the procedure.…”

“…3 Infusion of filtered blood products, bacteremia and severe mucositis can also cause false-positive elevations. 3 A recent publication involving critical care patients who had cardiac artery bypass grafting showed elevated BDG levels, speculated to be from the membranes used during the procedure. 4 Our patient had 3 consecutive elevated BDG assays with no evidence to support active fungal infection or factors known to cause false-positive results.…”