Brown nails as clues for shock diagnosis

Abstract

A previously healthy 60-year-old Japanese male farmer presented with shock, initially unresponsive to fluid resuscitation. Upon incidental observation of brown nail discoloration, adrenal insufficiency was suspected, confirmed by elevated ACTH levels. The timely recognition of nail hyperpigmentation led to the diagnosis of tuberculous Addison's disease, allowing for appropriate treatment and resolution of the condition.