A previously healthy 60-year-old Japanese male farmer presented with shock, initially unresponsive to fluid resuscitation. Upon incidental observation of brown nail discoloration, adrenal insufficiency was suspected, confirmed by elevated ACTH levels. The timely recognition of nail hyperpigmentation led to the diagnosis of tuberculous Addison's disease, allowing for appropriate treatment and resolution of the condition.
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A previously healthy 60-year-old Japanese male farmer presented with shock, initially unresponsive to fluid resuscitation. Upon incidental observation of brown nail discoloration, adrenal insufficiency was suspected, confirmed by elevated ACTH levels. The timely recognition of nail hyperpigmentation led to the diagnosis of tuberculous Addison's disease, allowing for appropriate treatment and resolution of the condition.
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Weill Cornell Medicine, Department of Dermatology, New York, NY, USA. Electronic address:
Longitudinal melanonychia (LM), a brown-black band on one or multiple nails, is commonly encountered in clinical practice. Benign LM may be due to exogenous (external, blood, bacterial, mycotic) or endogenous (melanin) pigment. Histopathologically, melanin-derived LM may result from overproduction of melanin by a normal number of melanocytes (melanocytic activation) due to physiologic, local, systemic, iatrogenic, syndromic, and drug-induced causes, or from benign (nail matrix nevus and lentigo) or malignant (nail unit melanoma [NUM]) melanocyte hyperplasia.
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