LAUSR

A 60-year-old man presented with a slowly increasing subungual growth over the left ring finger of 5 years duration (Fig. 1). The growth was associated with bleeding on minor manipulation. There were no associated systemic complaints. The patient had received multiple courses of antibiotics from local practitioners without much improvement. On examination, a fleshy growth measuring 1 9 1 cm was seen below the nail plate of the left ring finger, extending from the distal end of the nail plate to the proximal nail fold. It resulted in the uplifting and yellowish discoloration of the nail plate. Growth showed an erythematous, shiny, irregular surface with minimal purulent discharge. The proximal nail fold was swollen with the surface showing prominent telangiectasias, and an area of adherent necrotic crust was noted on the fingertip with marked tenderness. There was no lymph node enlargement in the affected extremity. An x-ray of the hand revealed erosion over the distal phalanx bone. No lymphadenopathy could be appreciated on the ultrasound axilla, and the contrast-enhanced computed tomography scan showed no organ involvement.