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The lateral sections showed inflammation at 3 levels as follows the enthesis of the interosseous ligament and collateral ligament, periosteum, and nail epithelium. In the 3 specimens, the inflammatory foci involving entheses and nails were prominent and never contiguous. This suggests that DIP PsA is not merely an extensor enthesitis and that the nail unit remains a microanatomical structure independent from the extensor enthesis, even with severe DIP PsA. We present the case of a 56-year-old male with myelodysplastic syndrome (MDS)
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