• Anupam Gupta, Mahsan Farokhi, Sapna Shah, Terence McGarry, Martin Warshawsky, and Oleg Epelbaum.
• Division of Pulmonary/Critical Care Medicine, Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: guptaa16@nychhc.org.
• Chest. 2016 May 1; 149 (5): e147-50.

AbstractAn 80-year-old man presented because of superficial head trauma sustained after falling from bed. On review of systems, he reported worsening dyspnea on exertion, nonproductive cough, and weight loss over the preceding 2 to 3 months. There was no report of chest pain or leg swelling. He had a past medical history of hypertension, coronary artery disease, subclinical hypothyroidism, and renal cell carcinoma treated with partial right nephrectomy approximately 1 year before this presentation. Two months earlier he had been evaluated in the dermatology clinic for painful, dystrophic fingernails. At that time he was diagnosed with acropachy with onycholysis and suspected superinfection, and after failing to improve with vinegar soaks and topical antimicrobials, he underwent surgical nail removal on the second and fourth digits of the right hand. Histological examination of the operative specimens revealed dystrophic nails with negative fungal stains. His medications included levothyroxine, hydrochlorothiazide, and clopidogrel. He had never smoked and had done clerical work until retirement. He was originally from Colombia.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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