Development of Terry's nails after a gastrointestinal bleed

Abstract

Terry's nails are characterized by white opacification of the nails with effacement of the lunula and distal sparing. Described originally in 1954 by Dr. Richard Terry as a common fingernail abnormality in patients with hepatic cirrhosis, Terry's nails are now a known sequelae of other conditions such as congestive heart failure, chronic kidney disease, diabetes mellitus, and malnutrition. Often all nails of the hands are affected. Treatment of the underlying disease may result in resolution. We present a case of a 77-year-old man who developed Terry's nails following an acute gastrointestinal bleed and subsequent hemorrhagic shock. The development of Terry's nails after a gastrointestinal bleed has not been previously reported.

Keywords: Gastrointestinal bleed; Terry’s nails; leukonychia.

Figure 1.

(a) Our patient’s fingernails in the upper half revealing whitening or ground-glass opacity of nearly the entire nail bed of each fingernail, indistinguishable from the lunula, with a narrow band of normal pink nail bed at the distal border consistent with Terry’s nails. Normal fingernails at the bottom half are for comparison. (b) A closer view of Terry’s nails in our patient.