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Onychomycosis with gray-green staining caused by Fusarium solani

Summary

A 76-year-old gardener developed a gray-green discolored thumbnail that was initially thought to be a bacterial infection. Testing revealed it was actually caused by a fungus called Fusarium solani, which unusually produced dark-green colonies. The patient was successfully treated by removing the affected nail and applying an antifungal medication, demonstrating the importance of proper fungal testing for nail infections.

Background

Fusarium solani is a non-dermatophytic mold that can cause onychomycosis, typically presenting with white or yellow nail discoloration. This case presented with an unusual gray-green nail appearance that initially suggested green nail syndrome caused by Pseudomonas aeruginosa.

Objective

To report and characterize a unique case of onychomycosis caused by Fusarium solani with gray-green nail staining, including mycological identification and clinical treatment outcomes.

Results

Two fungal colonies were identified: light-brown (strain #6-1002-3) and dark-green (strain #6-1002-4), both genetically confirmed as Fusarium solani complex. Bacterial cultures remained negative throughout. Treatment with 10% effinaconazole liquid combined with nail plate removal resulted in complete clinical improvement by day 270.

Conclusion

This is the first reported case of Fusarium solani producing dark-green colonies in fungal culture, creating gray-green nail discoloration. Nail plate removal combined with effinaconazole treatment successfully resolved the infection, demonstrating the importance of fungal testing to differentiate onychomycosis from bacterial green nail syndrome.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39640202, DOI: 10.1016/j.mmcr.2024.100684
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