Hyperpigmentation, nail dystrophy and alopecia with generalised intestinal polyposis: Cronkhite-Canada syndrome

A 62-year-old Malaysian woman presented with a constellation of skin signs including alopecia, hyperpigmentation and nail dystrophy. On questioning, a history of diarrhoea, taste disturbance and weight loss was found. The onset of these changes coincided with the administration of thyroxine prescribed for a benign multinodular goitre. Hormonal investigations showed no abnormality and no underlying malignancy was found. Investigation of the diarrhoea showed a protein-losing enteropathy with generalized intestinal polyposis and non-specific histology. A diagnosis of Cronkhite-Canada syndrome was made. Treatment with prednisone and nutritional support has been partially effective.