Unravelling Beau's lines as a potential indicator of severe immune response in COVID-19 and reinfection
  • Aris P. Agouridis
    School of Medicine, European University Cyprus, Nicosia, Cyprus; Department of Internal Medicine, German Oncology Center, Limassol, Cyprus
  • Evangelia E. Ntzani
    Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece; Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, USA
  • Georgia Anastasiou
    Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
  • Fotios Barkas
    Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
  • Evangelos C. Rizos
    School of Medicine, European University Cyprus, Nicosia, Cyprus; School of Nursing, University of Ioannina, Ioannina, Greece

Keywords

Beau's lines, COVID-19, interleukin-6

Abstract

Background: Beau's lines are transverse grooves in the nail plate that result from transient interruption of the growth of the proximal nail matrix. These rare nail disorders can be triggered mostly by infections or systemic diseases.
Case Description: We describe a 65-year-old man who presented with nail changes on all fingernails. The patient, a non-smoker with no medication history, had severe immune responses during two hospitalisations, 9 and 4 months ago, for COVID-19. Both hospitalisations were accompanied by markedly elevated interleukin-6 levels, and treatment with tocilizumab on top of dexamethasone was required. The present examination revealed Beau's lines which were associated with both prior COVID-19 infections.
Conclusions: Although nail changes look harmless, seeking Beau's lines during the physical examination might indicate past severe COVID-19 infection and a higher probability for reinfection and rehospitalisation.

VIEW THE ENTIRE ARTICLE

References

  • Löser CR, Nenoff P, Mainusch O, Dippel E, Balakirski G. Common diseases of the nail: diagnosis and therapy. J Dtsch Dermatol Ges 2021;19:1761–1775.
  • Kim BR, Yu D-A, Lee SR, Lim SS, Mun J-H. Beau's lines and onychomadesis: a systematic review of characteristics and aetiology. Acta Derm Venereol 2023;103:adv18251.
  • Ryu H, Lee HJ. Beau's lines of the fingernails. Am J Med Sci 2015;349:363.
  • Park J, Li K. Images in clinical medicine. Multiple Beau's lines. N Engl J Med 2010;362:e63.
  • Berard R, Scuccimarri R, Chédeville G. Leukonychia striata in Kawasaki disease. J Pediatr 2008;152:889.
  • Alobaida S, Lam JM. Beau lines associated with COVID-19. Cmaj 2020;192:E1040.
  • Ide S, Morioka S, Inada M, Ohmagari N. Beau's lines and leukonychia in a COVID-19 patient. Intern Med 2020;59:3259.
  • Wolf GK, French LE. Beau-lines of the fingernails in association with pediatric SARS-CoV-2 infections. J Dtsch Dermatol Ges 2021;19:744–745.
  • Deng J, Ngo T, Zhu TH, Halverstam C. Telogen effluvium, Beau lines, and acral peeling associated with COVID-19 infection. JAAD Case Rep 2021;13:138–140.
  • de Paula JA, Franck CL, Justino SR, Leite LS, Ramos Júnior O, Rabito EI. Beau's line in COVID-19 after a long ICU stay. Nutr Hosp 2022;39:945–948.
  • Ricardo JW, Lipner SR. Case of de novo nail psoriasis triggered by the second dose of Pfizer-BioNTech BNT162b2 COVID-19 messenger RNA vaccine. JAAD Case Rep 2021;17:18–20.
  • Lam K, Yim E. Transverse leukonychia and Beau lines following COVID-19 vaccination. Cutis 2022;110:E28–E31.
  • Kutlu O, Demircan YT, Yildiz K, Kalkan G, Demirseren DD, An I, et al. The effect of COVID-19 on development of hair and nail disorders: a Turkish multicenter, controlled study. Int J Dermatol 2023;62:202–211.
  • Views: 297
    HTML downloads: 21
    PDF downloads: 119


    Published: 2024-01-17
    Issue: 2024: Vol 11 No 2 (view)


    How to cite:
    1.
    Agouridis AP, Ntzani EE, Anastasiou G, Barkas F, Rizos EC. Unravelling Beau’s lines as a potential indicator of severe immune response in COVID-19 and reinfection. EJCRIM 2024;11 doi:10.12890/2024_004281.