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A case of refractory onychomycosis caused by Kloeckera apiculata: Successful treatment with itraconazole

Summary

A 32-year-old man had a stubborn fungal nail infection caused by an extremely rare yeast called Kloeckera apiculata that didn’t respond to three different antifungal treatments over several years. After being identified through specialized laboratory testing including genetic sequencing, the infection was successfully cured with a 3-month course of the oral antifungal medication itraconazole. This case is notable because it is only the fourth known case of this rare fungal infection in humans and the first one to achieve complete cure with itraconazole treatment.

Background

Onychomycosis is a common fungal infection affecting up to 10% of the population worldwide. Kloeckera apiculata is an extremely rare cause of onychomycosis in humans, with only 3 previously reported cases in the medical literature.

Objective

To document a case of refractory onychomycosis caused by Kloeckera apiculata and describe the successful treatment approach. This case represents the fourth documented occurrence of this uncommon infection and the first reported successful cure.

Results

The patient was successfully treated with a 3-month course of oral itraconazole 200 mg daily after failing topical tavaborole, oral terbinafine, and oral fluconazole. Complete clinical and mycological cure was achieved with negative fungal culture at 6 months post-treatment and no recurrence after 12 months of observation.

Conclusion

This case documents the first successful treatment of Kloeckera apiculata onychomycosis with oral itraconazole, achieving complete clinical and mycological cure. Oral itraconazole should be considered as first-line treatment for future cases of nail infection caused by this uncommon pathogen.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39314640, DOI: 10.1016/j.mmcr.2024.100669
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