Nail Pigmentation Changes Associated with Azidothymidine (Zidovudine)

Azidothymidine (now zidovudine; Retrovir, Burroughs Wellcome Company, Research Triangle Park, North Carolina) is an agent that appears to be efficacious in the treatment of the acquired immunodeficiency syndrome in patients with a history of Pneumocystis carinii pneumonia (1). Information on the type and frequency of side effects with this agent, however, is limited (2, 3). We noted progressive pigmentation of all ten fingernails in two black patients after they had received azidothymidine orally at a dose of 200 mg every 4 hours for 2 to 6 weeks. Neither patient was receiving any other drug. A 36-year-old black woman with a history of P. carinii pneumonia after infection with human immunodeficiency virus began receiving azidothymidine in oral doses of 200 mg every 4 hours according to the Burroughs Wellcome Azidothymidine Treatment Investigational New Drug Protocol. Six weeks later the patient went to an emergency room for evaluation of "cyanosis" after having noted a darkened bluish appearance at the bases of all ten fingernails. Arterial blood gas pressures were within normal limits. A follow-up examination confirmed a 3-mm transverse discoloration of all ten fingernails that progressed distally as azidothymidine therapy was continued. She