Pincer nails following arteriovenous fistula creation

A 68-year-old woman with end-stage renal disease secondary to diabetic nephropathy started chronic hemodialysis with a right internal jugular central venous catheter. After 4 months, she underwent creation of a right radiocephalic arteriovenous fistula. Although she noted slightly increased curvature of her fingernails prior, over the 2 months following fistula creation she developed severe pincer deformities of her second, third, and fifth fingernails on the same side as the fistula (Figure 1). She also developed gradually worsening pain in the affected nail beds after the deformities were well established (Figure 2) but had no symptoms or signs to suggest a steal syndrome or other hand ischemia.