Non-dermatophytic onychomycosis caused by Fusarium spp. in a 58-year-old agricultural worker: a case report
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Keywords
agricultural worker, non-dermatophytic onychomycosis, Fusarium spp
Abstract
Introduction: Onychomycosis is a nail infection caused by dermatophytes, non-dermatophytes, and yeast. Fusarium spp. is one of the non-dermatophyte molds that can cause onychomycosis. A superficial infection with these fungi can lead to an invasive infection. Few case reports of onychomycosis caused by Fusarium spp. in Indonesia have been documented.
Case description: We present a case of a 58-year-old male patient with a history of hepatitis B, atopic dermatitis, and corticosteroid consumption. Hyperkeratosis with a yellowish color was observed, and small particles of cornified material were discovered beneath both of his great toenails. Onychomycosis is assessed based on clinical symptoms. Mycological examinations were done by KOH examination and culture. Macroscopic examination of the culture revealed a white, cottony-looking mold with a non-pigmented reverse. Microscopic examination showed the septate hyphae, the canoe-shaped macroconidia, and the oval microconidia. We diagnosed onychomycosis caused by Fusarium spp. Based on macroscopic and microscopic examination. The antifungal susceptibility test showed a high MIC against several antifungal agents.
Conclusion: It is important to be cautious for onychomycosis caused by Fusarium spp. infection as superficial infection can progress to invasive disease. Given the high prevalence of Fusarium spp. resistance to the antifungal group, antifungal treatment selection should be carefully considered.
References
2. Maskan Bermudez N, Rodríguez-Tamez G, Perez S, Tosti A. Onychomycosis: Old and New. J Fungi. 2023;9(5):1–13.
3. Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, et al. Onychomycosis: An Updated Review. Recent Pat Inflamm Allergy Drug Discov. 2019;14(1):32–45.
4. Grover C, Khurana A. Onychomycosis: Newer insights in pathogenesis and diagnosis. Indian J Dermatol Venereol Leprol. 2012;78(3):263–70.
5. Uemura EVG, Barbosa MDS, Simionatto S, Al-Harrasi A, Al-Hatmi AMS, Rossato L. Onychomycosis Caused by Fusarium Species. J Fungi. 2022;8(4):7–18.
6. Lu LY, Ou JH, Hui RCY, Chuang YH, Fan YC, Sun PL. High Diversity of Fusarium Species in Onychomycosis: Clinical Presentations, Molecular Identification, and Antifungal Susceptibility. J Fungi. 2023;9(5).
7. Larone D, Westblade LF, Burd EM, Lockhart SR, Procop GW, Walsh TJ. Larone’s Medically Important Fungi: A guide to identification (7th edition). 7th editio. American Society for Microbiology; 2023.
8. Alexander BD, Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi. Vol. 3. 2018. 50 p.
9. Kim DM, Suh MK, Ha GY, Sohng SH. Fingernail onychomycosis due to Aspergillus niger. Ann Dermatol. 2012;24(4):459–63.
10. Gupta AK, Summerbell RC, Venkataraman M, Quinlan EM. Nondermatophyte mould onychomycosis. J Eur Acad Dermatology Venereol. 2021;35(8):1628–41.
11. Diongue K, Ndiaye M, Seck MC, Diallo MA, Badiane AS, Ndiaye D. Onychomycosis Caused by Fusarium spp. in Dakar, Senegal: Epidemiological, Clinical, and Mycological Study. Dermatol Res Pract. 2017;2017:1–5.
12. Christopher PM, Winaya KK. Onychomycosis Caused by Aspergillus niger : A Case Report of An Unusual Etiological Agent. 2022;11(1):2020–3.