I was presented today with an interesting dilemma; perhaps some of you have other thoughts. One of my patients is a boy who is approximately 3 years old. He has been diagnosed with holoprosencephaly, failure to thrive, and global developmental delay. He suffered a fairly minor case of Streptococcal Pharyngitis in mid-December, 2001, that responded promptly to antibiotic administration. Today, he presented to clinic with progressive loss of his fingernails. Specifically, several of the nail have what appear to be Beau's Lines. Of those nails with lines, many have started to come off at the nail bed. In fact, a few have come off completely! I've never seen this before but understand many things can cause Beau's lines, among which is included zinc deficiency and severe febrile illness. I understand some medications can cause the condition, but he's not taking anything of which I am aware right now. Has anyone ever seen this happen after Strep Throat? He had a normal Zn level two years ago when we did an extensive work-up to pursue his FTT. I've gone ahead and requested another Zn level, just to be sure.... Any other thoughts would be appreciated! Thanks, Christine B. Myers, M.D.