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Nail Changes in a Child with Acute Lymphoblastic Leukemia

Question:
Govind Kendre, Shruti Mantri, Sunil Hilalpure, Suraj Goyanka, Leo Prince, Murlidharan C
Department of Clinical Hematology, Seth G.S. Medical College, KEM Hospital, Parel, Mumbai.

Address for correspondence: Dr. Govind Kendre, Department of Clinical Haematology, Seth G.S. Medical College, KEM Hospital, Parel, Mumbai. Email: govindken143@gmail.com

Key Words: Chemotherapy, daunorubicin, methotrexate, vincristine, cyclophosphamide, nail, chromonychia, leukonychia

A 15-year-old girl, diagnosed with B cell acute lymphoblastic leukemia, receiving the BFM-90 protocol presented with transverse white and bluish black bands on the nails of all fingers and toes (Figure 1). She had received daunorubicin, vincristine, cyclophosphamide, and methotrexate as a part of her chemotherapy protocol. These nail changes were observed after the completion of the consolidation phase of the BFM protocol.

Figure 1: Nail changes

What is the cause of her nail discoloration?