BH10: Nailing the Diagnosis

This case study discusses a 60-year-old man with a history of malignant melanoma, type II diabetes, and bilateral carpal tunnel syndrome, who presented with nail changes and lesions on his hands. Initially, his symptoms were thought to be related to diabetes, but further investigation revealed a pleural effusion and reduced cardiac ejection fraction, suggesting amyloidosis. A biopsy confirmed amyloidosis, and cardiac MRI indicated advanced cardiac involvement. The nail changes, including koilonychia and longitudinal fissuring, were hypothesized to result from amyloid infiltration. This case underscores the importance of considering amyloidosis in patients with similar nail findings and assessing for systemic involvement.