A Probable Case of Alternarial Onychomycosis / 대한의진균학회지

Alternaria is a common saprophyte that is not usually pathogenic in humans. Alternarial onychomycosis is very rare and it is difficult to make a diagnosis of onycholycosis by moulds. In Korean literature, clinical findings of onychomycosis by Scopulariopsis brevicaulis, Aspergillus sp., Fusarium sp. were reported. But clinical finding of alternarial onychomycosis has not been reported. We report a probable case of alternarial onychomycosis in a 67-year-old Korean farmer. Some of the infected nails showed paronychia, onychia, loss of nail plate, black discoloration of proximal part of the nail plate and proximal nail folds. And some of them showed combined findings of proximal subungual onychomycosis and distal and lateral subungual onychomycosis. Repeated microscopic findings showing typical macroconidia and brownish hyphae of Alternaria were observed on three consecutive KOH smears with one-week interval. But cultures were not successful. Extraction of nail plates with oral antifungal and antibiotic treatment was only partially effective.

A Case of Total Dystrophic Onychomycosis Caused by Candida albicans in Diabetes Mellitus / 대한의진균학회지

Onychomycosis is the invasion of the healthy nail plate by species of dermatophytes, as well as a variety of non-dermatophytes (yeasts and moulds) which may cause nail infection, particularly after tissue damage by trauma or disease. Candida albicans and C. parapilosis are the most commonly isolated yeasts from abnormal toenails. The patient was a 20-year-old woman who presented with a thickened and crumbly nail plate of the right second finger for 4 months. Initially, a tiny yellowish macule appeared under the nail plate, which gradually involved the entire nail plate, resulting in complete deformity of the nail. She was diagnosed with diabetes mellitus 4 months ago and her blood sugar level was controlled with subcutaneous insulin injections. Direct microscopic examination of the scrapings prepared with potassium hydroxide revealed fungal elements. Repeated cultures on Sabouraud dextrose agar showed cream to white colored, semi-glossy, flat colonies, which were findings consistent with C. albicans. Complete extraction of the involved nail with meticulous curettage of the nail bed was made. She has been taking 150 mg of oral fluconazole weekly since August 2003 and showed substantial improvement.