Systemic amyloid light-chain (AL) amyloidosis is a multisystem disorder caused by extracellular deposition of monoclonal immunoglobulin light chains. Cutaneous manifestations are diverse, but nail involvement is uncommon and may lead to diagnostic delay. We report the case of a 53-year-old man presenting with progressive dystrophy affecting all 20 nails for 18 months. Clinical examination revealed marked nail plate atrophy and onychorrhexis. Dermoscopy demonstrated nail plate atrophy, subungual hyperkeratosis, and splinter hemorrhages. A longitudinal lateral nail-bed biopsy revealed abundant amorphous eosinophilic deposits in the papillary dermis on hematoxylin and eosin staining. Congo red staining confirmed amyloid deposition. Subsequent systemic evaluation revealed markedly elevated free lambda light chains and bone marrow plasmacytosis, establishing the diagnosis of systemic AL amyloidosis associated with multiple myeloma. This case highlights that unexplained progressive pan-ungual dystrophy may represent an early manifestation of systemic amyloidosis. Early recognition and nail-unit biopsy can facilitate prompt diagnosis of this potentially fatal systemic disease.

ObjectiveTo describe the prevalence, clinical manifestations, histopathological features, and antibody profile associated to skin involvement in patients with catastrophic antiphospholipid syndrome (CAPS).MethodsWe performed a cross-sectional study of the patients included in the "CAPS Registry," a registry developed by the European Forum on Antiphospholipid Antibodies (aPL)1,2 This database contains data from patients with CAPS collected from April 1992 to December 2024. Demographic clinical manifestations, laboratory features (including aPL antibodies), pathological findings in involved skin, and outcome were retrieved.ResultsCutaneous involvement was described in 377 episodes (47%) from 361 patients. A female sex prevalence of 49.4% was observed. The average age was 39.4 (SD ± 17.9) years. The more frequent skin manifestations observed were livedo reticularis (17.6%), skin necrosis (13%), ischemic ulcers (10.4%), skin ischemic (9.7%), skin purpura (7.1%), gangrene (5%), splinter haemorrhages (2.6%), and Raynaud's phenomenon (1.5%). The most frequently affected organs in CAPS episodes with skin involvement were kidneys (72%), lungs (61%), central nervous system (54.5%), and heart (54.4%). Thrombocytopenia and hemolysis features were more common in patients with skin involvement (p < 0.05 for all). Thrombotic microangiopathy was the predominant pathological finding, present in 82 (68.3%) episodes. No difference regarding mortality were found in episodes with or without skin involvement (29.3% vs 32.1%, p = 0.42).ConclusionThe presence of skin involvement in patients with CAPS is frequent. The most frequent manifestations were livedo reticularis and skin necrosis. Skin involvement does not seem to be associated to mortality.

Nail lichen planus is a chronic inflammatory condition that may be isolated to the nail, resulting in longitudinal nail ridging, trachyonychia, and splinter hemorrhages, and may be highly refractory to conventional treatment. The management of nail lichen planus remains challenging because of the lack of standardized treatment guidelines, and the efficacy of existing therapies, both topical and systemic, is often inconsistent or unsatisfactory. Emerging reports have suggested that abrocitinib, a selective Janus kinase 1 inhibitor, may be safe and effective in treating severe nail lichen planus. This report describes the case of a woman in her late 40s with refractory nail lichen planus who was successfully treated with abrocitinib.

Tricuspid valve infective endocarditis (TVIE) is an uncommon entity, especially when compared to left-sided infective endocarditis. Right-sided infected infective endocarditis (RSIE) accounts for approximately 5 – 10% of all cases of infective endocarditis (IE).  The overwhelming number of cases of RSIE involve the tricuspid valve with some estimates as high as 90%. The majority of TVIE are associated with IV drug use (IVDU). Given the rise of IVDU in the United States, rates of TVIE have also increased significantly since 2006. Along with IVDU, hemodialysis catheters, pacemakers, and defibrillator leads are also risk factors. Staphylococcus aureus is the most common organism, which causes TVIE.  However, various skin flora, as well as various Staphylococcus and Streptococcus species can infect the tricuspid valve. Duke’s Criteria is used to establish the diagnosis of TVIE. However, there are certain aspects of TVIE which can make it detection difficult. Such features include absent murmur, concurrent pneumonia, and less peripheral phenomena such as splinter hemorrhages. Regardless, TVIE is treatable and has favorable outcomes if detected and treated early in its course.  Although RSIE and TVIE are increasing in prevalence, antibiotics and surgical options remain a mainstay of successful treatment.

A 17-year-old previously healthy girl presented with 7 days of fever and classical peripheral findings including Osler's nodes, Janeway lesions, splinter hemorrhages, and Roth's spots. Echocardiography revealed a large vegetation attached to the posterior mitral leaflet. Blood culture later grew methicillin-sensitive Staphylococcus aureus. Despite antibiotic therapy, the vegetation increased in size with splenic embolization, requiring urgent mitral valve replacement. This case highlights the enduring diagnostic value of classical clinical signs, now rarely seen in high-income settings but still encountered in resource-limited regions, and emphasizes the importance of early echocardiographic evaluation in such presentations.

South Asian and Chinese individuals are the largest and fastest-growing ethnoracial groups in Canada, yet they remain underrepresented in dementia research. To address this gap, we established the CAnadian Multi-Ethnic Research on Aging (CAMERA) study.

Progressive claudication of the upper extremity is uncommon and can be misattributed to cervical radiculopathy or even shoulder pathology, such as tendonitis or bursitis. We report a patient presenting to the emergency department with several months of worsening left upper-extremity pain initially managed as suspected radiculopathy, but, in retrospect, was upper-extremity claudication. This was discovered through the presence of lesions beneath the fingernails of the left hand, splinter hemorrhages. A computed tomographic angiography (CTA) of the chest for aortic and vascular evaluation demonstrated a mural thrombus partially occluding the left subclavian artery. The patient was admitted for further management and observation. Following initiation of systemic anticoagulation, symptoms had significantly improved, and the patient was discharged home in stable condition. This case underscores the diagnostic importance of bedside examination and vascular imaging when evaluating atypical upper-extremity claudication. This also highlights arterial thrombus as a potentially reversible cause of upper-extremity pain when promptly recognized and treated.