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The refractory nailbed ulceration caused by Candida parapsilosis after nail extraction

Summary

An 82-year-old woman developed a stubborn ulcer on her toenail bed after having the nail surgically removed to treat an infected nail fold. Testing revealed the ulcer was caused by a yeast called Candida parapsilosis, which typically causes infections after physical trauma or injury to the skin. Treatment with an antifungal medication called fluconazole successfully healed the ulcer over three months. This is the first reported case of this specific type of infection following nail removal and highlights the importance of properly identifying the cause of chronic nail infections.

Background

Candida parapsilosis is the second or third most common non-albicans Candida species with a wide range of clinical presentations. Superficial infections caused by C. parapsilosis are comparatively uncommon, and refractory nailbed ulceration following this pathogen is rarely reported in the literature.

Objective

To report the first documented case of refractory nailbed ulceration caused by Candida parapsilosis following nail extraction in an immunocompetent patient and to discuss the diagnostic and therapeutic approach to this unusual presentation.

Results

Candida parapsilosis was identified from the nailbed culture and confirmed through molecular identification. Histopathological examination revealed typical ulcer features with epidermal absence and dermal inflammation. The isolate showed susceptibility to fluconazole (MIC = 0.5μg/mL). Complete healing of the ulceration was achieved after three months of fluconazole therapy (50 mg/day) with no recurrence at six-month follow-up.

Conclusion

This case represents the first reported instance of refractory nailbed ulceration caused by C. parapsilosis after nail extraction. The findings emphasize the importance of pathogenic examination in chronic paronychia and suggest that C. parapsilosis-related infections may be more common in traumatic nail conditions than previously recognized. Careful diagnostic evaluation and appropriate antifungal therapy are essential for successful treatment outcomes.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39507512, DOI: 10.1016/j.mmcr.2024.100677
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