Chemotherapy casted shadow: Mees’ and Beau's lines

[摘要] A 28-year-old female received six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy totreat diffuse large B-cell lymphoma. She completed her treatment (seeFigure 1) 3 weeks before this photograph. Examination showed multiple white lines on the fingernails, known as Mees’ lines. Mees’ linesare transverse, nonblanching white bands that run parallel to the lunulaaround the entire nail bed. The lines matched the start of each cycle,with the distance between the lines representing the time intervalbetween cycles. In this patient, four lines can be identified with consistent intervals on the body of her nails, while the fifth and sixth lines areseen at a more significant distance at the nail-free edge. This might berelated to treatment delay after cycle 2 (40 days) due to intensive careunit admission with sepsis and coronavirus disease (COVID-19) pneumonia. In the third and fourth cycles (the outer lines on the nail bed), wecan see roughness and indentation (on the left-hand thumb and indexfinger), representing Beau’s lines. Beau’s lines are transverse depressions in the nail plate caused by transient cell division interruption inthe proximal nail matrix. Both lines are commonly seen in patients witha history of chemotherapy exposure.

[关键词] Beau's lines;chemotherapy toxicity;DLBCL;Mees’ lines;RCHOP