Intended for healthcare professionals

Endgames Spot Diagnosis

A patient with cancer and nail pigmentation

BMJ 2016; 353 doi: (Published 03 May 2016) Cite this as: BMJ 2016;353:i2346
  1. Abhishek Maiti, resident physician postgraduate year 21,
  2. Sreyasi Bhattacharya, visiting physician2
  1. 1Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
  2. 2Department of Cardiology, Pacific Cardiology Associates, Fremont, CA, USA
  1. Correspondence to: A Maiti abhishek.maiti{at}

A 32 year old African-American woman with stage 2B distorted B cell lymphoma of the cervix was admitted because of febrile neutropenia. Apart from fevers, she had black discoloration of her nails (fig 1). She had completed three cycles of a dose adjusted R-EPOCH regimen (rituximab, etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin) and also took acetaminophen (paracetamol)-hydrocodone, and ondansetron. …

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