Onychomycosis with Green Nail Discoloration in an Immunocompromised Patient: A Case Report

Nurrachmat Mulianto, Trya Oktaviani

Abstract


Candida onychomycosis is an infection of the nails of the hands or feet caused by Candida sp. Green nail discoloration (GND) is a greenish discoloration of the nail due to bacterial infection, fungal infection or polymicrobial infection. Candida species fungi are fungal pathogens reported to be associated with GND. A 22-year-old female complained of greenish-yellow colored right thumb nail since 3 months ago. The patient has a history of systemic lupus erythematosus (SLE) since 1 year ago. Dermatological status examination of the digiti I manus dexter region showed onychodystrophy, subungual hyperkeratosis and greenish yellow discoloration of the nail plate. Based on the results of history, physical examination and supporting examination, the patient was diagnosed onychomycosis with GND. The diagnosis of onychomycosis can be established by history taking, physical examination and supporting examination in the form of dermoscopy, microscopic nail scraping with 20% KOH, fungal culture and nail biopsy with Periodic Acid-Schiff's (PAS) histochemical painting. Green nail discoloration is one of the clinical manifestations in cases of onychomycosis. Candida sp. is reported as one of the fungal pathogens associated with GND. Management of onychomycosis requires a long time and aims to eliminate fungal pathogens and improve nail condition.


Keywords


Onychomycosis, systemic lupus erythematosus, immunocompromised, Candida albicans

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References


. Quattlebaum T, Sonido C. Green Toenail Discoloration. Am Fam Physician. 2021;104(6):645–6.

. Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, et al. Onychomycosis: an updated review. Recent Pat Inflamm Allergy Drug Discov. 2020;14(1):32–45.

. Monteagudo B, Figueroa O, Suárez-Magdalena O, Méndez-Lage S. Green Nail Caused by Onychomycosis Coinfected With Pseudomonas aeruginosa. Actas Dermosifiliogr [Internet]. 2019;110(9):783–5. Available from: https://www.actasdermo.org/en-green-nail-caused-by-onychomycosis-articulo-S1578219019302689

. Ray A, Bonorden MJL, Pandit R, Nkhata KJ, Bishayee A. Infections and immunity: associations with obesity and related metabolic disorders. J Pathol Transl Med. 2023;57(1):28–42.

. Borba OSM, Ogawa MM, Kirsztajn GM, Tomimori J. Onychomycosis in immunocompromised population: Phenotypic and molecular identification. Mycoses [Internet]. 2023 Nov 1;66(11):1018–24. Available from: https://doi.org/10.1111/myc.13634

. Shi L, Feng Y, Shi D. Two Cases of Superficial Fungal Infection Caused by Non-Albicans Candida Species Manifest Greenish-black Discoloration. Infect Drug Resist. 2024;17:665–72.

. Forouzan P, Cohen PR. Fungal Viridionychia: Onychomycosis-Induced Chloronychia Caused by Candida parapsilosis-Associated Green Nail Discoloration. Cureus. 2021 Dec;13(12):e20335.

. Aljehani FH, Alluhaibi R, Alhothali OS, Fageeh SM, Al Ahmadi GA, Malyani RZ. An Unusual Presentation of Candidal Onychomycosis: A Case Report. Vol. 15, Cureus. United States; 2023. p. e43222.

. Maskan Bermudez N, Rodríguez-Tamez G, Perez S, Tosti A. Onychomycosis: old and new. Journal of Fungi. 2023;9(5):559.

. Su CF, Lai CC, Li TH, Chang YF, Lin YT, Chen WS, et al. Epidemiology and risk of invasive fungal infections in systemic lupus erythematosus: a nationwide population-based cohort study. Ther Adv Musculoskelet Dis. 2021;13:1759720X211058502.

. Ge G, Yang Z, Li D, de Hoog GS, Shi D. Onychomycosis with greenish-black discolorations and recurrent onycholysis caused by Candida parapsilosis. Med Mycol Case Rep. 2019;24:48–50.

. Lipner SR, Scher RK. Onychomycosis: Clinical overview and diagnosis. J Am Acad Dermatol. 2019;80(4):835–51.

. Nargis T, Pinto M, Shenoy MM, Hegde S. Dermoscopic features of distal lateral subungual onychomycosis. Indian Dermatol Online J. 2018;9(1):16–9.

. Bodman MA, Krishnamurthy K. Onychomycosis. StatPearls [Internet]. 2017;5(1):1–12.

. Lu H, Shrivastava M, Whiteway M, Jiang Y. Candida albicans targets that potentially synergize with fluconazole. Crit Rev Microbiol. 2021;47(3):323–37.

. Falotico JM, Lapides R, Lipner SR. Combination therapy should be reserved as second-line treatment of onychomycosis: a systematic review of onychomycosis clinical trials. Journal of Fungi. 2022;8(3):279.

. Yazdanpanah S, Jabrodini A, Motamedi M, Zomorodian K, Kharazi M, Shabanzadeh S, et al. Species distribution and antifungal susceptibility profiles of yeasts isolated from onychomycosis: a cross-sectional study with insights into emerging species. Antonie Van Leeuwenhoek. 2023 Dec;117(1):6.

. Behera B, Kowe PA, Viswan P. Green nail with proximal onycholysis: Clinical and dermoscopic features. Cosmoderma. 2024;4(13):13.

. Rather S, Keen A, Shah FY, Yaseen A, Farooq S, Bakhshi A. Candidal Onychomycosis: Clinicoepidemiological Profile, Prevailing Strains, and Antifungal Susceptibility Pattern-A Study from a Tertiary Care Hospital. Indian J Dermatol. 2021;66(2):132–7.

. Litaiem N, Mnif E, Zeglaoui F. Dermoscopy of Onychomycosis: A Systematic Review. Dermatol Pract Concept. 2023 Jan;13(1).




DOI: https://doi.org/10.33854/heme.v7i3.1816

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