title: A 28-Year-Old Male Patient with Nail Tumors, Skin Lesions, and Epilepsy.
abstract: BACKGROUND
  Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the development of benign hamartomas in multiple organs. Most patients with TSC exhibit cutaneous manifestations.
  
  
  METHODS
  We report a 28-year-old patient with multiple pink papules at the proximal nail fold of several toes.
  
  
  RESULTS
  Histopathological analysis of a biopsy of a papule was consistent with an ungual fibroma. Histopathological analysis of a biopsy of an elevated skin-colored plaque at the lower back was diagnostic for a Shagreen patch. These findings were consistent with a clinical diagnosis of TSC. This patient was subsequently referred to a multidisciplinary TSC clinic for further screening, which revealed a giant cell astrocytoma and multiple subependymal tubers. Annual monitoring was recommended. The skin lesions were treated with topical rapamycin ointment.
  
  
  CONCLUSIONS
  Recognizing dermatological manifestations of TSC is of importance to allow early diagnosis. TSC should be considered as a differential diagnosis in the case of ungual fibromas, even in older patients.
authors.affiliation: Department of Dermatology, Reinier de Graaf Gasthuis, Delft, The Netherlands; Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Deepak M W
authors.initials: DM
authors.lastname: Balak
authors.affiliation: Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Zonnenberg
authors.affiliation: Department of Pathology, Reinier de Graaf Gasthuis, Delft, The Netherlands.
authors.forename: Juliette M J
authors.initials: JM
authors.lastname: Spitzer-Naaijkens
authors.affiliation: Department of Dermatology, Reinier de Graaf Gasthuis, Delft, The Netherlands.
authors.forename: Mieke M
authors.initials: MM
authors.lastname: Hulshof
keywords: Angiofibromas; Shagreen patch; Topical rapamycin; Tuberous sclerosis complex; Ungual fibroma