Nail Shedding: A Case Report.

ABSTRACT

Aims: The etiology of nail shedding in an 85-year-old man as well as predisposing and precipitating factors were evaluated, focusing on whether nail loss was secondary to infection or not. Presentation of Case An 85-year-old man was examined for complete detachment and loss of the nail plates of the index and middle fingers of his right hand. There were no previous nail disorders or a recent traumatic injury. He was non-smoker and was not receiving any drug therapy before nail loss. Clinical symptoms and signs persisted after 10 days empirical use of antibiotics and local treatment. Culture samples by that time indicated an Enterobacter cloacae local infection. He was treated with topical application of the gentamycin injection solution on the nail beds. There was normal regrowth of the nails. No abnormality of the nail unit of both fingers was evident 2 years later. Discussion: The pathogenesis of nail shedding in our patient was assessed. Although a causal relation of nail loss and a primary Enterobacter cloacae infection was highly suggestive, other causes such as missed minor trauma, ischemia or idiopathic could not be excluded. Conclusion: A primary Enterobacter cloacae infection was the most likely cause of an acute nail shedding of the index and middle fingers of the right hand in an 85-year-old man. Treatment with local use of the gentamycin injection solution was proved a welltolerated, safe and efficacious mode of treatment.