A 25 year-old man presented to the emergency department with one month history of severe, unusual nail lesions preceded by mouth ulceration (Figure 1). The physical examination revealed periungual blisters, inflammation and edema of the proximal, lateral and posterior nails folds of all fingernails and toenails (Figures 2 and 3). We noticed several flaccid skin bullae on his back (Figure 1). The patient was otherwise healthy. He worked in Africa for 2 years duration.