An 8 year old boy with a history of perinatally acquired HIV, who was CDC immunological category 3 (T CD4+ = 4/μl),¹ and had been treated for six years with zidovudine and ritonavir, developed white lines in all fingernails three months after having pneumonia (fig 1). The lines disappeared within five months, following nail growth. He died one year later as a result of sepsis.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

 White lines in all fingernails.

An 8 month old infant, who was HIV positive, CDC category 3 (T CD4+ = 408/μl), and had been under treatment with zidovudine, ritonavir, and lamivudine, for four months, developed visible white lines in all fingernails two months after his mother’s death (fig 2). The lesions grew out with the nail within five months. He is now 4 years old and is controlled with high dose active antiretroviral therapy.

• Download figure
• Open in new tab
• Download powerpoint

Figure 2

 Transverse bands of leukonychia.

White nails discolorations are frequent dermatological findings. They result from nail plate abnormal keratinisation. Generalised involvement of the nail matrix is responsible for transverse leukonychia, which can induce complete or partial whitening of the nail.² Traumatic injuries are the main causative factor. Acute systemic illnesses and emotional stresses may be trigger factors.³ The underlying pathophysiological causes are unclear. Transverse leukonychia are a “late mirror” which indicate the severity of an illness or emotional problem.