Reproduction Abstracts

In hyperemesis gravidarum (HG), pregnant women experience significant nausea and vomiting during pregnancy. While case reports largely describe comorbidities during pregnancy in women suffering from HG, few studies have reported on patient outcomes post-partum. Nail abnormalities can provide insight into a variety of systemic diseases. Prior to the reporting of this case, no publications could be identified to date describing any nail findings as a post-partum pregnancy outcome related to HG. A 36-year-old female presented to dermatology with toenail pain and bleeding during two recent pedicures when the nail technician attempted to clip her first toenails. Her past medical history was significant for two severe HG pregnancies, most recently two years prior, requiring extensive hospitalization. Additionally, at 6 months pregnant she showed her obstetrician an abnormal dent in all of her toenails. At the time of her dermatology visit, she had normal appearing nail plates although they were notably long. The hyponychium of her bilateral first toenails, however, was attached to the ventral nail plate with very scant free margin. The patient was diagnosed with acquired pterygium inversum unguis (PUI). Photos from 6 months of pregnancy showed deep transverse grooves in the nail plates. The grooves were approximately 5 mm distal from the proximal nail fold and the patient was given a diagnosis of Beau lines. Tian, MacGibbon, Mullin, Martin and Fejzo published a unique landmark paper describing a breadth of patient outcomes in HG. Further characterization of their findings is an important future research opportunity. Although many healthy pregnant women experience nail changes, this case adds the first known report of Acquired Pterygium Unguis Inversum (PUI) associated with either pregnancy or HG and Beau’s lines with HG. PUI is a rare condition in which the hyponychium attaches to the ventral nail plate and obliterates the distal nail groove.Previously reported causes may include acrylic nails, connective tissue diseases, leprosy and stroke. Beau’s lines coincide with nail matrix arrest usually due to severe illness, hospitalization or other stressful events. Toenails grow approximately 1mm per month, therefore this patient’s Beau’s line would coincide with her first hospitalization at approximately 5 weeks pregnant.

References

1. Tian R, MacGibbon K, Martin B, Mullin P, Fejzo M. Analysis of pre- and post-pregnancy issues in women with hyperemesis gravidarum. Auton Neurosci. 2017 Jan;202:73-78. DOI: 10.1016/j.autneu.2016.07.005

2. Erpolat S, Eser A, Kaygusuz I, Balci H, Kosus A, Kosus N. Nail alterations during pregnancy: a clinical study. Int J Dermatol. 2016 Oct;55(10):1172-5. DOI: 10.1111/ijd.13316

3. Caputo R, Cappio F, Rigoni C, Scarabelli G, Toffolo P, Spinelli G, Crosti C. Pterygium inversum unguis. Report of 19 cases and review of the literature. Arch Dermatol. 1993 Oct;129(10):1307-9. DOI: 10.1001/archderm.129.10.1307

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