Physical Exam: The patient's nails had subungual hyperkeratosis and
distal elevation of the nail plate (Figs 1,2). The mother had similar but
more pronounced nail changes (Fig 1). The patient's tongue was coated with
adherent white plaques (Fig 3), that were KOH-negative. There was marked
yellow-brown discoloration of the fingernails and toenails.
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