Behcet's Disease with Half and Half Nail and Pulmonary Artery Aneurysm

Abstract

To the Editor: Half-and-half nail, also known as Lindsay nail, is defined as a red to brown discoloration occupying 20 to 50 percent of the distal fingernails on both hands.1Scher RK Farrell DS Yellow nail syndrome and half-and-half nail.Arch Dermatol. 1987; 123: 710-711Crossref PubMed Scopus (9) Google Scholar We report a patient who had Behcet's disease and half-and-half nail. A 31-year-old man presented with bilateral pleuritic chest pain, hemoptysis, fever and mild attacks of dyspnea. His medical history revealed that he had recurrent oral and genital ulcerations for the past 16 years. Behcet's disease was diagnosed in another hospital three years ago, and he has been irregularly taking varying doses of colchicine since. Medical examination was remarkable for subcutaneous thrombosed veins on the anterior surface of his right forearm and multiple elevated hypopigmented macular lesions on his left forearm. Half-and-half nails were also noticed (Fig 1). It was learned from the patient that the color change in his fingernails was present before the administration of colchicine therapy and there were other individuals in his family with similar nail appearance. Laboratory values were all within normal limits. Mycologic research on the nails was negative. Pulmonary digital subtraction angiography (DSA) revealed an aneurysm in the left main pulmonary artery, including its lower lobar branch. Obstruction of some of the peripheral pulmonary artery branches were also noted. This patient's history and clinical picture is compatible with the diagnosis of Behcet's disease in its complete form.2Shimizu T Ehrlich GE Inaba G Hayashi K Behcet's disease.Semin Arthritis Rheum. 1979; 8: 223-260Abstract Full Text PDF PubMed Scopus (583) Google Scholar The clinical picture of pulmonary vascular involvement usually consists of fever, chest pain, hemoptysis and recurrent opacities on the chest x-ray film.3Durieux P Bletry O Huchon G Wechsler B Chretien J Godeau P Multiple pulmonary arterial aneurysms in Behcet's disease and Hughes-Stovin syndrome.Am J Med. 1981; 71: 736-741Abstract Full Text PDF PubMed Scopus (128) Google Scholar, 4Efthimiou J Johnston C Spiro SG Turner-Warwick M Pulmonary disease in Behcet's syndrome.Q J Med. 1986; 58: 259-280PubMed Google Scholar Our patient presented with these symptoms and signs. Obliteration of the small branches of the pulmonary arteries, in addition to an aneurysm, was demonstrated. We were unable to find any reported case of half-and-half nail associated with Behcet's disease in the literature. A brownish-red band covers 20 to 50 percent of the nail beds in half-and-half nails.5Lindsay PG The half-and-half nail.Arch Intern Med. 1967; 119: 583-587Crossref PubMed Scopus (111) Google Scholar There may be also increased melanin in the nail plates, but this was absent in this case. It is usually diagnosed in patients with renal disease and uremia, and infrequently in healthy persons.1Scher RK Farrell DS Yellow nail syndrome and half-and-half nail.Arch Dermatol. 1987; 123: 710-711Crossref PubMed Scopus (9) Google Scholar, 5Lindsay PG The half-and-half nail.Arch Intern Med. 1967; 119: 583-587Crossref PubMed Scopus (111) Google Scholar, 6Bencini PL Crosti C Sala F Graziani G Montagnino G Fenomeno “half-and-half nail” nell'uremico.Giorn It Derm Vener. 1985; 120: 289-291PubMed Google Scholar We concluded that this patient with Behcet's disease has half-and-half nails; an additional renal or hepatic disease was excluded in the face of clinical and laboratory findings.