Abstract
Koilonychia is a known sequela of chronic and severe iron deficiency anemia. The pathogenesis is not well understood, but is postulated to be attributed to weakening of the underlying nail connective tissue secondary to poor oxygenation of the distal extremities. Because of the lower prevalence of koilonychia in developed nations, its clinical presentation in the U.S. is of particular significance. In the following case, a female patient presented with angina and heart palpitations of four month duration as well as severe anemia of unknown origin. Physical exam was notable for koilonychia, most prominent in the 1st - 4th digits of the right hand as well as the 1st and 2nd digits of the right foot.
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