Lindsay’s nails in a patient followed up for antiphospholipid syndrome

A 55-year-old Caucasian woman was referred by a dermatologist to the immunology outpatient clinic due to Raynaud’s syndrome (capillaroscopic findings consistent with the primary Raynaud's syndrome) and skin lesions with the livedo reticularis type located on the extremities. Additionally, matte white discoloration of the proximal portions of the nail plates of the hands was observed, with a sharp line of demarcation to the brown-colored distal parts (figs. 1, 2). The patient’s history revealed one miscarriage before 10 weeks of pregnancy. The diagnostic work-up found no evidence of internal organ damage, except for thickening of the mitral valve leaflets seen on echocardiogram and no indications of thromboembolic incidents. Serological tests showed antinuclear antibodies with a granular fluorescence pattern at a titer of 1 : 160 and antibodies with a Golgi fluorescence pattern at a titer of 1 : 640. Also, the presence of IgM anticardiolipin antibodies at a significant titer was detected twice (over 12 weeks apart), and IgM antibodies against β2-glycoprotein were identified once. The patient did not meet the Sydney criteria or the 2023 ACR/EULAR criteria to diagnose antiphospholipid syndrome. Consequently, a diagnosis of undifferentiated connective tissue disease with features of antiphospholipid syndrome was established. Treatment with hydroxychloroquine and acetylsalicylic acid was initiated. The patient continues to be under dermatological and immunological follow-up.
Lindsay’s nails (LN; also known as ‘half and half nails’) are a condition described in 1962 by physicians William B. Bean and James Clifton in two patients with azotemia, and in 1967 by Philip G. Lindsay in 25 patients (after reviewing a group of 1,500 individuals) with chronic kidney disease [1, 2]. Lindsay’s nails is a condition characterized by a clearly visible transverse division of the nail plate into two distinctly colored portions. The proximal part appears matte white, resembling a crystal, while the distal part is darker in color, ranging from pink to red-brown, covering between 20% and 60% of the nail surface [1–4]. LN can affect either a single nail apparatus (NA) of one extremity or involve all the NAs of the patient’s upper (more commonly) and/or lower extremities. Lindsay’s nails is a type of apparent leukonychia: the translucency of the nail plate is preserved (unlike in true leukonychia and pseudoleukonychia), and the white color fades on pressure [1, 2].
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