Zidovudine-induced nail pigmentation in a 12-year-old boy
In December 2011, a 12-year-old boy was brought by guardians to dermatology OPD for nail pigmentation involving all fingernails. About 4 years back, ART was started for him with stavudine-based regimen (12 mg stavudine + 60 lamivudine + 100 mg nevirapine) because of too low hemoglobin level. But after improvement in hemoglobin level, he has been shifted to zidovudine-based regimen (zidovudine 300 mg + lamivudine 150 mg + nevirapine 200 mg) since last 1 year. After 3 months of initiating the new regimen, he noticed bluish-brown discoloration of thumbnails that gradually spread to other fingernails [Figure and ] and grew in intensity over time [Figure and ]. The discoloration began proximally and progressed distally to involve free edge of nails. There was no history of trauma, use of coloring agents, any triggering factor, or abnormal skin or mucosal pigmentation. He was not taking drugs other than antiretrovirals. Past history was not significant. His parents had died due to AIDS.\nOn examination, he was averagely built, nourished, and fully immunized. His general and systemic examinations were normal. Local examination revealed diffuse bluish-brown discoloration of all fingernails, but it was more marked in thumbnails. It did not disappear on compression of nail plate. Nails were brittle with loss of lunulae and periungual changes [Figure and ].\nComplete blood count revealed low hemoglobin level (9 gm %). His CD4 count was 755/mm3. No specific treatment was given for nail pigmentation. The patient and guardians were counseled about harmless nature of this adverse drug reaction (ADR) and he is receiving the same regimen at present.