May 1997

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A 6 month old white male was referred by his pediatrician for evaluation of white plaques on his tongue present since one month of age, and resistant to treatment with Nystatin. He was otherwise healthy and developing normally.

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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