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A 46-year-old woman with metastatic sarcoma who had been treated with five cycles of doxorubicin, ifosfamide, and mesna chemotherapy presented with two symmetrical, horizontal white lines on all of her fingernails but not on her toenails. A diagnosis of Muehrcke's lines was made. Muehrcke's lines are the two smooth white bands that run parallel to the lunula across the width of the nail. The lines are nonpalpable and, unlike Beau's lines, do not indent the nail itself. Normal-appearing pink nail-bed tissue is seen between the two white lines, and thumb involvement is rare. Muehrcke's lines are a nonspecific finding that may be associated with periods of metabolic stress, which transiently impairs the ability of the body (and particularly of the liver) to synthesize proteins. Although the use of chemotherapy is one potential cause of Muehrcke's lines, as illustrated in this patient, so are infections and trauma. Three months after presenting with Muehrcke's lines, the patient died from progressive metastatic disease.
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