CRCM  Vol.4 No.1 , January 2015
Proximal White Onychomycosis in an Immunocompetent Patient: A Case Report
Abstract: Objective: Onychomycosis is a diagnosis of fungal organisms in the nail unit. It frequently occurs in both the immunocompetent and immunocompromised patient. A variant of onychomycosis is proxiaml onychomycosis that occurs on the most proximal aspect of the nail. Proximal onychomycosis is known to be commonly associated with immunocompromised status. Study Design: A case report of a veteran who presented a dermatology clinic with complaint of solitary nail discoloration that was recalcitrant to over-the-counter therapy including topical hydrogen peroxide and foot soaks without improvement. Results and Conclusions: This individual case report demonstrates that pedal proximal onychomycosis can be associated with non-dermatophyte organisms, identified as Fusarium species, in immunocompetent individuals. The finding of pedal proximal onychomycosis caused by a Fusarium non-dermatophytic mold has not been reported. The veteran was successfully cured of the condition with treatment via oral terbinafine for a ninety-day course while monitoring patient’s liver function test for any complications.
Cite this paper: Schmidt, B. and Holmes, C. (2015) Proximal White Onychomycosis in an Immunocompetent Patient: A Case Report. Case Reports in Clinical Medicine, 4, 41-44. doi: 10.4236/crcm.2015.41010.

[1]   Ahn, K.J. (1994) A Case of White Superficial Onychomycosis. Korean Journal of Dermatology, 32, 931-933.

[2]   Habif, T.P., Ed. (2010) Clinical Dermatology. 5th Edition, Saunders Elsevier, Philadelphia, 491-523.

[3]   Hay, R.J. (2009) Dermatophytosis and Other Superficial Mycoses. In: Mandell, G.L., Bennett, J.E. and Dolin, R., Eds., Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th Edition, Churchill Livingstone Elsevier, Philadelphia, Chapter 267.

[4]   Phillips, P. (1996) New Drugs for the Nail Fungus Prevalent in Elderly. JAMA, 276, 12-13.

[5]   Elewski, B.E. and Hay, R.L. (1996) Update on the Management of Onychomycosis: Highlights of the Third Annual International Summit on Cutaneous Antifungal Therapy. Clinical Infectious Diseases, 23, 305-313.

[6]   Zaias, N., Glick, B. and Rebell, G. (1996) Diagnosing and Treating Onychomycosis. The Journal of Family Practice, 42, 513-518.

[7]   Gupta, A.K., Taborda, P., Taborda, V., Gilmour, J., Rachlis, A., Salit, I., et al. (2000) Epidemiology and Prevalence of Onychomycosis in HIV-Positive Individuals. International Journal of Dermatology, 39, 746-753.

[8]   Tlacuilo-Parra, A., Guevara-Gutierrez, E., Mayorga, J., Garcia-De La Torre, I. and Salazar-Paramo, M. (2003) Onychomycosis in Systemic Lupus Erythematosus: A Case Control Study. The Journal of Rheumatology, 30, 1491-1494.

[9]   Schlefman, B.S. (1999) Onychomycosis: A Compendium of Facts and a Clinical Experience. The Journal of Foot & Ankle Surgery, 38, 290-302.

[10]   Odom, R.B. (1996) New Therapies for Onychomycosis. Journal of the American Academy of Dermatology, 35, S26-S30.

[11]   Elewski, B.E. (1993) Clinical Pearl: Proximal White Subungual Onychomycosis in AIDS. Journal of the American Academy of Dermatology, 29, 631-632.

[12]   Weinberg, J.M., Koestenblatt, E.K., Don, P.C., White, S.M., Stein, M.N. and Bamji, M. (1999) Proximal White Subungual Onychomycosis in the Immunocompetent Patient: Report of Two Cases and Review of the Literature. Acta Dermato-Venereologica, 79, 81-95.

[13]   Piraccini, B.M., Morelli, R., Stinchi, C. and Tosti, A. (1996) Proximal Subungual Onychomycosis Due to Microsporum canis. British Journal of Dermatology, 134, 175-177.

[14]   Baran, R., Tosti, A. and Piraccini, B.M. (1997) Uncommon Clinical Patterns of Fusarium Nail Infection: Report of Three Cases. British Journal of Dermatology, 136, 424-427.

[15]   Dordrain-Bigot, M.L., Baran, R., Baixench, M.T. and Bazex, J. (1996) Fusarium Onychomycosis. Annales De Dermatologie et De Venereologie, 123, 191-193.

[16]   Silver-Lizama, E. and Logemann, H. (1996) Proximal White Subungual Onychomycosis in AIDS. International Journal of Dermatology, 35, 290-291.

[17]   Noppakun, N.M. and Head, E.E. (1986) Proximal White Subungual Onychomycosis in a Patient with Acquired Immune Deficiency Syndrome. International Journal of Dermatology, 25, 586-587.

[18]   Tosti, A., Piracinni, B.M. and Lorenzi, S. (2000) Onychomycosis Caused by Nondermatophytic Molds: Clinical Features and Response to Treatment of 59 Cases. Journal of the American Academy of Dermatology, 42, 217-224.

[19]   Hilmioglu-Polat, S., Metin, D.Y., Inci, R., Dereli, T., Kilinc, I. and Tümbay, E. (2005) Non-Dermatophytic Molds as Agents of Onychomycosis in Izmir, Turkey—A Prospective Study. Mycopathologia, 160, 125-128.

[20]   Gupta, A.K., Jain, H.C., Lynde, C.W., Macdonald, P., Cooper, E.A. and Summerbell, R.C. (2000) Prevalence and Epidemiology of Onychomycosis in Patients Visiting Physicians’ Offices: A Multicenter Canadian Survey of 15,000 Patients. Journal of the American Academy of Dermatology, 43, 244-248.