Onychogryphosis due to Aspergillus niger in a poorly controlled type 2 diabetes mellitus

Abstract

Onychogryphosis mostly affects the big toes. The nail plate rises upwards at first then deviates laterally, elderly patients, and homeless with marks of neglect are more commonly affected by this condition. Here, we report a case of onychomycosis caused by Aspergillus niger in a 74-year-old female with type 2 diabetes mellitus discovered 8 month earlier, and managed by oral hypoglycemic. The patient presented with a black discoloration and a milky white base and onychogryphosis of the right big toenail. Direct microscopic examination of scrapings after potassium hydroxide (KOH) preparation revealed dichotomous septate hyphae. Repeated cultures on Sabouraud's dextrose agar (SDA) without cycloheximide produced the same black velvety colonies. Onychogryphosis is a particular nail condition to recognize and treat due to pain and consequences. Our patient was started on oral itraconazole at 500 mg twice daily, associated to amorolfine 5% lacquer for 3 months, which lead to partial remission after 8 weeks.A careful clinical examination combined with mycological tests can be decisive in the diagnosis of fungal onychogryphosis, especially for patients with diabetes mellitus.