Pseudo-clubbing complicated by dermatophyte onychomycosis.

Abstract

1. Here, we described a case of chronic paronychia without any Candida species involved, but complicated by onychomycosis, caused by Trichophyton rubrum. A 46-year-old woman presented with a 3-year history of swelling of the right hand’s third and fourth nail folds, and a 1-year history of nails alteration. The patient stated that the dermatoses had never been treated, and there was no history of trauma, or family onchoymycosis. Dermatological examination showed that most nails of the involved fingers were lost (Fig. 1A), and the proximal and lateral nail folds were obviously swollen, and developed a pseudo-clubbing (Fig. 1B). No other nails and skin were affected. The woman was otherwise healthy. Direct microscopic examination of nail clippings revealed branching fungal hyphae. Culture growth and slide culture showed T. rubrum (Fig. 2A, B). Those of the nail folds were negative. Histopathological examination showed squamous cell hyperplasia, with parakeratosis and chronic inflammation in the dermis (Fig. 2C, D). The radiograph of fingers revealed soft tissue swelling, and no abnormality of the bones. A diagnosis of chronic paronychia, complicated by onychomycosis caused by T. rubrum, was made. Itraconazole 200 mg twice daily for one week, and topical triamcinolone acetonide acetate cream 0.05% on the nail folds twice daily for one month, were prescribed. Mycological examination after one month was negative, but there was no obvious progress of the swelling lesions, and no new nail grown out. She was disappointed, and sub