Abstract：
An 87-year-old man was referred to our department for evaluation of his dystrophic left fingernails that developed progressively for the past 2 years. His past medical history included hemodialysis for 10 years for chronic renal failure. Examination of his nails revealed xanthonychia, onycholysis, Beau\'s lines, and marked hyperkeratosis of the nail plate involving all of his left fingernails. However, his right fingernails were not affected (Figure 1). He also had edema of the left hand associated with puffy fingers but without trophic disorders (Figure 2). Mycologic exam-ination with direct microscopy and culture of his affected nails were negative. Antinuclear antibodies (ANAs), Scl-70 (anti-topoisomerase) antibodies, anti-centromere antibodies, and anti-RNA polymerase III antibodies were all negative. Capillaroscopy showed no abnormalities. An X-ray of his left hand showed no bony abnormalities. For the past 5 years, the patient had suffered from paresthesia and numbness on the left hand in the area of the median nerve. Paresthesia, pain, burning, and tingling involved mainly the thumb, plus the index and middle fingers, but not the little finger. Carpal tunnel syndrome (CTS) was suspected. Neurologic examination and electromyography (EMG) confirmed the diagnosis of CTS of the left hand explaining his unilateral onychodystrophy. The patient was then referred to a hand surgeon for his CTS.
摘要：
一名87岁的男子被转介给我们部门，以评估他在过去2年中逐渐发展的营养不良的左指甲。他的既往病史包括慢性肾衰竭血液透析10年。检查他的指甲发现黄甲病，甲状腺溶解症,Beau\的台词,指甲板上明显的角化过度，涉及他所有的左指甲。然而,他的右指甲没有受到影响（图1）。他还患有与浮肿手指相关的左手水肿，但没有营养障碍（图2）。直接显微镜检查真菌学检查和受影响指甲的培养均为阴性。抗核抗体（ANA），Scl-70（抗拓扑异构酶）抗体，抗着丝粒抗体，抗RNA聚合酶Ⅲ抗体均为阴性.毛细管镜检查未见异常。他左手的X光片显示没有骨骼异常。在过去的5年里,患者在正中神经区域出现感觉异常和左手麻木。感觉异常,疼痛,燃烧,刺痛主要涉及拇指，加上食指和中指，但不是小手指。怀疑腕管综合征（CTS）。神经系统检查和肌电图（EMG）证实了左手CTS的诊断，解释了他的单侧甲营养不良。然后将患者转诊给手外科医生进行CTS。
