Bertrand Richert

Nail Pyogenic Granuloma following Treatment with Blinatumomab

tory of acute lymphoblastic leukemia for which he had had a bone marrow transplant 1 year earlier. Ten months later, he had a recurrence of the disease and was then treated with blinatumomab. The only other medications the patient was taking were aciclovir, omeprazole, and posaconazole, which he has been taking for several months now. Blinatumomab was administered as a continuous infusion delivered at a constant flow rate using an infusion pump. Each cycle of treatment was 4 weeks of continuous infusion followed by a 2-week treatment-free interval. The patient developed paronychia and periungual/subungual PG 6 weeks after the initiation of blinatumomab. Only the 2 great toenails were involved without any pain (Fig. 1). As the patient sought medical advice to only know the cause of the condition and was not in pain, a conservative symptomatic topical treatment associating a potent steroid and an antibiotic (betamethasone valerate and fusidic acid, Fucicort®, Léo Pharma) under occlusion at night was prescribed. The patient was then lost for follow-up. The mechanisms underlying the development of periungual/ subungual PG after infusion of blinatumomab remain unclear. So far, drugs that are known to be responsible for PG are systemic retinoids [2] (isotretinoin, etretinate), topical retinoids [3, 4] (tretinoin, tazarotene), and antiretroviral therapy [5] (indinavir, lamivudine). More recently, PG have been described during antineoplastic therapy especially with epidermal growth factor inhibitors [6] (cetuximab, lapatinib, panitumumab, gefitinib, erlotinib), where it occurs in 60% of all patients, and more rarely with capecitabine, 5-fluorouracil, mitoxanthrone, and docetaxel [2, 7]. Dear Editor, Blinatumomab is a new targeted immunotherapy approved by the US Food and Drug Administration (FDA) for the treatment of relapsed or refractory Ph-negative acute lymphoblastic leukemia in adults. It is a specific CD19-directed CD3 T cell engager, which will result in destroying malignant B cells [1]. We report the first case of periungual/subungual pyogenic granuloma (PG) following blinatumomab treatment. A 34-year-old male presented to the nail consultation for the spontaneous arising of easily bleeding periungual and subungual granulomas in the lateral sulcus of both great toenails. He has never suffered from ingrowing nails and has had no pedicure ever in his life. He was clipping his nails himself. The patient had a hisReceived: June 9, 2017 Accepted: July 17, 2017 Published online: August 31, 2017

Subungual Solitary Angiokeratoma Simulating a Squamous Cell Carcinoma

Subungual angiokeratoma is extremely rare. Only 1 case is reported in the literature, presenting as a longitudinal pigmented band on a toenail. We report a case of a subungual angiokeratoma on a fingernail of a 43-year-old woman, clinically mimicking a squamous cell carcinoma. Medical imaging revealed a soft tissue tumor and erosion of the distal phalanx. Although extremely rare, solitary angiokeratomas may arise in the nail apparatus and should be added to the differential diagnosis of subungual warty tumors.

Erosive lichen planus: beyond the nails

Erosive Lichen Planus (ELP) is an inflammatory disorder clinically characterized by erosions and primary or secondary ulcerations. It may affect cutaneous surface (soles are often involved), the mucous membranes (especially genital-gingival) and the cutaneous appendages (nails and hairs). ELP restricted to the nails seems to be a rare variety of LP that may accompany mucosal and cutaneous disease (above all the soles of the feet); nail ELP(NELP) is characterized by erosions of the nail bed, acute inflammation of nail folds and permanent anonychia. This article is protected by copyright. All rights reserved.