Onychomycosis due to Exophiala jeanselmei.
BACKGROUND
Exophiala jeanselmei is a dematiaceous fungus that may cause invasive diseases, particularly among immunocompromised hosts. Most reports mention cutaneous or subcutaneous lesions, but no case of nail involvement due to this fungus has been reported until now.


METHODS
A 60-year-old man presented with hyperkeratosis and black coloration of the nails of the two thumbs and the two big toes of 4 years' duration. He was a renal transplant recipient and had been treated with prednisone and azathioprine. E. jeanselmei was present on direct examination, then isolated in cultures on repeated samplings from all pathologic nails. He was cured after 6 months of treatment with itraconazole.


CONCLUSIONS
We describe the first case of nail infection due to E. jeanselmei. Itraconazole, which provides a broad spectrum of action on fungal species and achieves high levels of active substance in many tissues, including the nails, appeared to be efficient upon such a nail localization of E. jeanselmei.
Boisseau-Garsaud
Anne-Marie
AM
Service de Dermatologie, Centre Hospitalier Universitaire de Fort de France, Martinique, France. garsaud@sasi.fr
Desbois
Nicole
N
Guillermin
Marie-Laurence
ML
Ossondo
Marlène
M
Gueho
Evelyne
E
Cales-Quist
Danielle
D
D005093:Exophiala / Q000302:isolation & purification*; D006229:Hand Dermatoses / Q000382:microbiology / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000473:pathology; D014009:Onychomycosis / Q000382:microbiology* / Q000473:pathology