Pregnancy‐associated acquired arteriovenous malformation of the nail unit: a novel cause of localized erythronychia

Abstract

Localized longitudinal erythronychia describes a solitary red streak limited to a single nail unit. Localized longitudinal erythronychia can be caused by both benign and malignant entities. Most commonly, the cause is a benign process, such as an onychopapilloma. We report a case of an acquired subungual arteriovenous malformation that presented as localized longitudinal erythronychia during pregnancy. To our knowledge, this is the first report of localized longitudinal erythronychia arising from a pregnancy-associated arteriovenous malformation of the nail unit.

Nail Unit Arteriovenous Hemangioma Presenting as Longitudinal Erythronychia

“…AVH is a distinct acquired vascular proliferation, often occurring in the skin or other soft tissues. They are rarely Likewise, only 2 cases of acquired vascular proliferations have had a similar clinical presentation to our case, that is, a red longitudinal band [10,14]. One was classified as a subungual capillary hemangioma, in an 80-year-old male with a 1-mm red longitudinal band involving the left thumbnail.…”

“…Acquired vascular proliferations, similar to the one in our case, have been categorized under a number of names, including subungual AVH, subungual capillary hemangioma, acquired digital arteriovenous (AV) malformations, subungual AV tumor, and subungual AV malformation. Ten cases involved the nail unit [8][9][10][11][12][13][14]. These acquired vascular proliferations have overlapping clinical and histopathological features, with one study proposing that they are on a morphologic continuum of one common entity, namely, a benign vasoformative proliferation [14].…”

“…Ten cases involved the nail unit [8][9][10][11][12][13][14]. These acquired vascular proliferations have overlapping clinical and histopathological features, with one study proposing that they are on a morphologic continuum of one common entity, namely, a benign vasoformative proliferation [14]. Patients typically presented with a blue (20%) or red (60%) nodule/ macule involving the nail bed or underneath the nail fold, with or without splitting and ridging, or as solely LLE (20%).…”

“…Summary of demographics, clinical, dermoscopic, imaging, and histopathology of nail unit vascular proliferations and nomenclature[5, 6, 7, 8, 9, 10, 11, 12,13,14] …”

Pigmentations of the Nails

“…onychopapilloma, a papillomatous-keratotic lesion of the distal matrix running all along the nail bed to the hyponychium. Other causes are subungual filamentous tumor, Bowen's disease, ungual lichen planus and subungual arteriovenous malformation [7]. As Bowen's disease is an important differential diagnosis a biopsy for histopathological examination is recommended if the diagnosis is not absolutely clear.…”