Spontaneous subungual hemorrhages in a patient with metabolic syndrome and hyperhomocysteinemia: a case report

Spontaneous (nontraumatic) subungual hemorrhages are not uncommon, however, given their low specificity, they usually do not become a reason for an in-depth investigation in the absence of other symptoms of diseases requiring diagnostics. However, it is generally accepted that the nail bed is one of the few areas of the human body available for life-time diagnostics of the state of microvessels and the process of microcirculation. In the presented clinical case, examination of a 38-year-old patient with spontaneous subungual hemorrhages on the toes revealed a number of metabolic disorders: hyperhomocysteinemia, lipid and carbohydrate metabolism disturbances. Genetic tests showed the presence of several single nucleotide polymorphisms in the genes of the folate cycle enzymes (MTHFR A1298C, MTRR A66G, MTR A2756G) in a heterozygous form. Based on the presented results of the patient's examination, the paper discusses the mechanisms and relevant clinical aspects of the relationship between hyperhomocysteinemia, disorders of carbohydrate metabolism, and microangiopathy.