Half-and-half nails in a patient on antituberculosis treatment

Description

A Nigerian-born British national aged 24 years presented to our tuberculosis (TB) clinic after a positive, screening, quantiFERON blood test. She had been in the country for 12 years, had no known exposure to TB and no previous medical history. She was counselled regarding the risks and benefits of treating latent TB and then, following normal liver and kidney function blood tests, was started on combined rifampicin and isoniazid. She returned 4 weeks later to follow-up clinic with no systemic symptoms or side effects but with nail changes as shown in figure 1.

Figure 1

Photograph November 2015 showing the nail changes across all fingers and close up.

The diagnosis is half-and-half nails, in this case caused by isoniazid, likely due to its effects on niacin metabolism. However, half-and-half nails are most commonly seen in renal failure, and therefore, renal function tests...

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