We describe a case of a 66 years old Italian woman, who requested medical consulting for brown discoloration of the 4th and 5th fingers of the left hand. The discromy had been observed for 2/3 years. She was unable to be more specific, because of the use of a brown colour nail lacquer, of the same hue as the discoloration, which was therefore camouflaging the discoloration itself. The patient referred that the discoloration was particularly difficult to remove even when using a brush. She acknowledged to be suffering of onychophagia (nail biting). The patient had been affected by bronchitis for 3 years. She was on therapy with anti-hypertensive and anti-gastritis drugs. Nail scrapings from dorsal surface of the nails examined microscopically revealed the presence of masses of compacted and distorted hyphae. Non conidia were observed. Cultured on sabouraud’s agar it resulted in growth of A. terreus for three consecutive times. No growth of dermatophytes was observed. Treatment with oral Itraconazol 400 mg/daily for 7 days for 3 pulses, combined with cyclopirox solution applied daily for 3 months, resulted in complete recovery from the onychomycosis and significant improvement of the bronchitis with final resolution. 1.5 years later, Aspergillus flavus onychomycosis of the left big toe was diagnosed and treated with the same therapy utilized for the finger’s nail aspergillosis with subsequent achievement of complete recovery. Onychomycosis caused by A. terreus seems under-reported. It is an uncommon pathology, yet regularly observed. This is based on our practice as well on scientific literature. Among its specific features the following are noteworthy: Fingers involvement is very rare, usually toes are affected. Typically clinical features include: white superficial onychomycosis with leuconychia spots. Brown discoloration alone is extremely rare. In the presence of a A. terreus onychomycosis, the nails are usually brittle. In this specific case they were very hard, probably due to the itaconic acid production of the strain. There was a strong adhesion of the fungal biofilm to the nail plate. The long delay in the diagnosis (3 years) was caused by the curious coincidence of the nail lacquer’s color being similar to the discoloration. The involvement of the bronchi took place because of the coincidental onycophagia. As for Fusarium spp., onychomycosis due to Aspergilli spp. equally shows to have female gender bias.
Full conference title:
18th International Society for Human and Animal Mycology
- ISHAM 18th (2012)