Bluish-gray fingernail discoloration due to the use of nivolumab

Abstract

Introduction

Immune checkpoint inhibitors have improved clinical outcomes in a wide range of cancers. While skin toxicity is not uncommon with immune checkpoint inhibitors, generalized nail discoloration has not been reported with their use in oncology.

Case report

Herein, we report a unique case of bluish-gray fingernail discoloration due to nivolumab therapy for relapsed melanoma.

Management and outcome: This condition reversed completely 10 weeks after nivolumab discontinuation. Naranjo nomogram assessment renders the causality relationship between nivolumab and nail discoloration probable.

Discussion

To our knowledge, this is the first case report of an unusual bluish-gray nail discoloration due to therapy with nivolumab. The mechanism by which nivolumab causes this side effect remains to be elucidated.