Alterations on Nailfold Videocapillaroscopy in Myelodysplastic Syndrome and Onychomycosis in a Female Smoker: Microvascular Dysfunction Without Connective Tissue Disease.

A 58-year-old female smoker diagnosed with myelodysplastic syndrome (MDS) presented with Raynaud's phenomenon and a "scleroderma-like" pattern on nailfold capillaroscopy. The capillaroscopic abnormalities were observed across all fingers, including those without clinical manifestations of onychomycosis. Over a two-year follow-up, there was no evidence of clinical or serological progression toward a connective tissue disease, particularly systemic sclerosis. This case underscores the potential contributory role of MDS and smoking in the development of microvascular dysfunction, presenting as capillaroscopic abnormalities in the absence of an underlying autoimmune disorder.