Subungueal-Splinter Hemorrhage an Early Sign of Thromboangitis Obliterans

Abstract

Subungueal splinter hemorrhage (S.U.S.H.) has been reported in various conditions and may herald a serious systemic disease. It has been related to miscellaneous conditions such as: sub- acute bacterial endocarditis, severe rheumatoid arthritis, uninfected mitral stenosis, trichinosis, peptic ulcer, hy pertension, neoplasm, trauma, and in some cases, is considered idiopath ic.1, 2 Some dermatologic conditions such as psoriasis, dermatitis, and fungal infections may also produce S.U.S.H. 3 It consists of "a homogeneous mass of blood in a layer of squamous cells, ad herent to the under surface of the nail, considered to be of embolic origin."1 In a brief review of pertinent medical literature on thromboangiitis obliter ans, we were unable to find a descrip tion of its occurrence in this disease.2, 4, 5 The earliest lesions described in this condition are "painful vesicles on the pulp of digits with intense hyperhemia and hypersensitivity of the surrounding skin."4 It is our opinion that S.U.S.H. is an earlier and quite useful sign of arte rial involvement as seen in the following cases observed in our vascular disease section.