Nail dystrophy due to dose-intensive chemotherapy

Abstract

A 27-year-old male was diagnosed with stage IIB Hodgkin’s lymphoma with bilateral involvement of cervical, supraclavicular and axillary lymph nodes. Additionally, he had a large mediastinal mass ([1/3 of the maximal thoracic diameter) and an elevated erythrocyte sedimentation rate ([30 mm/h) which classified as an advanced stage disease according to the treatment algorithm of the German Hodgkin’s Lymphoma Study Group (GHSG). Accordingly the patient was treated within the HD18 trial with two cycles of ‘‘escalated’’ BEACOPP [1] (bleomycin, etoposide, adriamycine, cyclophosphamide, vincristine, prednisone, and procarbazine) at a 3-week interval. An interim fluorodeoxyglucose positron emission tomography performed after completion of the second cycle did not reveal residual lymphoma activity. The patient therefore was randomised to receive only two more cycles of escalated BEACOPP. On physical examination a month after completion of therapy, the patient showed four white rings on all finger nails, one for every cycle of chemotherapy comparable to year rings in tree trunks. Another patient, a 31-year-old female was also diagnosed with stage IIB Hodgkin’s lymphoma and bilateral, perihilar involvement and a mediastinal mass of 9.5 cm. Despite a negative PET result after two cycles of BEACOPP, the patient was randomized to receive another six cycles within the standard treatment arm. Figure 1b shows her fingernails after four cycles of dose-intensive chemotherapy. Post-chemotherapy dystrophy of the nails is regularly encountered in daily oncologic practice, e.g., up to 60% of