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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old man was referred for impairment of the second finger of the right hand with suspected onychomycosis&#46; The case history included a family history of insulin-dependent diabetes mellitus and 2 relatives who died due to liver disease of unknown origin&#46; During the examination&#44; we observed a brown-purplish area with distinct edges&#44; corresponding to the reason for the consultation and compatible with subungual hematoma&#46; There was a notable white-pink coloration arranged half-and-half on all nails of the hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Laboratory tests showed an increase in transaminases&#44; with a predominance of the cytolytic pattern &#40;glutamic oxaloacetic transaminase 205&#8239;IU&#47;L and gamma-glutamyl transferase 300&#8239;IU&#47;L&#41; compared with the cholestatic pattern &#40;total bilirubin 0&#46;5&#8239;mg&#47;dL&#44; gamma-glutamyl transferase 65&#8239;IU&#47;L and alkaline phosphatase 178&#8239;IU&#47;L&#41;&#46; Protein electrophoresis showed hypergammaglobulinemia due to IgG&#46; The autoimmunity study showed high titers of antinuclear &#40;1&#47;320&#41;&#44; anti-smooth muscle &#40;1&#47;320&#41;&#44; liver and&#47;or kidney microsomal &#40;1&#47;160&#41; and soluble liver antigen&#47;liver pancreas &#40;1&#47;320&#41; antibodies&#46; The results of a complete hepatic viral serology were negative&#44; ruling out hepatitis of infectious origin&#46; The patient was referred to the Department of Gastroenterology for treatment and follow-up of autoimmune hepatitis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Half-and-half nails or Terry&#8217;s nails are an uncommon finding&#59; however&#44; recognizing the meaning of this sign is crucial for a correct approach and for the association with severe internal organ impairment&#46; The condition has been related to cirrhosis&#44; chronic renal failure and congestive heart failure and has also been associated with patients with type 2 diabetes mellitus&#44; acute viral hepatitis&#44; vitiligo and tuberculoid leprosy&#46;</p></span>"
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Medicine in Images
DOI: 10.1016/j.rceng.2019.02.016
Terry’s nails as the first clinical sign of autoimmune hepatitis
Uñas de Terry como primer signo clínico de hepatitis autoinmune
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F.J. Navarro-Triviño
Corresponding author
fntmed@gmail.com

Corresponding author.
, L. Linares-González, T. Ródenas-Herranz
Servicio de Dermatología y Venereología, Hospital Universitario San Cecilio, Granada, Spain

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