Multiple Subungual Splinter Hemorrhages in the Antiphospholipid Syndrome: A Report of Five Cases and Review of the Literature

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Abstract
Multiple subungual splinter hemorrhages have been initially described as an important sign of subacute endocarditis. Secondly, they were reported in various other conditions, especially in isolated cases of primary antiphospholipid syndrome. We report five patients with multiple fingernail subungual splinter hemorrhages occurring in the course of antiphospholipid syndrome. Antiphospholipid syndrome was secondary to systemic lupus erythematosus in two, to Fasciola hepatica infection in one and was considered as primary in two. In all patients multiple subungual splinter hemorrhages occurred concomitantly with thrombotic events of diverse arterial sites. The mechanism of subungual splinter hemorrhages is most probably thrombotic.