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The refractory nailbed ulceration caused by Candida parapsilosis after nail extraction

Summary

An 82-year-old woman developed a stubborn wound on her toenail bed after having her nail surgically removed to treat an infection. When the wound did not heal for six months, doctors discovered it was caused by a fungus called Candida parapsilosis, which is normally found on skin but can cause infections when given the opportunity through wounds. After identifying the fungus, doctors treated her with an antifungal medication called fluconazole for three months, and her wound completely healed. This case shows the importance of testing chronic nail infections for their specific cause before performing surgery.

Background

Candida parapsilosis is the second or third most common non-albicans Candida species, though superficial skin and soft tissue infections caused by it are comparatively uncommon. The patient presented with a persistent nailbed ulceration following nail extraction surgery, which had not healed for six months despite prior antibiotic treatment for paronychia.

Objective

To report and analyze a case of refractory nailbed ulceration caused by Candida parapsilosis after nail extraction in an 82-year-old immunocompetent female patient. The authors aimed to emphasize the importance of pathogenic examination in chronic paronychia and careful choice of traumatic treatment.

Results

Candida parapsilosis was identified from culture on potato dextrose agar and confirmed through molecular identification (ITS sequence, Gene Bank accession MN699481). The isolate was susceptible to fluconazole (MIC = 0.5 μg/mL). After three months of fluconazole therapy (50 mg/day), the lesion completely healed with no recurrence at six-month follow-up.

Conclusion

This case represents the first reported refractory nailbed ulceration caused by Candida parapsilosis after nail extraction. The authors speculate that C. parapsilosis may have caused the initial paronychia and subsequently invaded the wound from nail removal, forming a difficult-to-heal nailbed ulcer. The case emphasizes the importance of pathogenic examination in chronic paronychia and careful consideration of traumatic treatment options.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39507512, DOI: 10.1016/j.mmcr.2024.100677
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