Nail psoriasis masqueraded by secondary infection with Rhodotorula mucilaginosa

Summary A 38‐year‐old man presented with whitish nail changes on all fingers as the sole symptom. The condition had developed within a few days and led to dystrophy of the proximal part of the nail plates. As microscopic examination of nail scrapings demonstrated budding hyphae and the patient worki...

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Bibliographic Details
Published inMycoses Vol. 56; no. 6; pp. 690 - 692
Main Authors Martini, K., Müller, H., Huemer, H. P., Höpfl, R.
Format Journal Article
LanguageEnglish
German
Published Germany 01.11.2013
Subjects
Acitretin - therapeutic use
Adult
Anti-Inflammatory Agents - therapeutic use
Antifungal Agents - therapeutic use
Betamethasone - therapeutic use
Biopsy
Calcitriol - analogs & derivatives
Calcitriol - therapeutic use
Coinfection - diagnosis
Coinfection - microbiology
Dermatologic Agents - therapeutic use
Humans
infection
Itraconazole - therapeutic use
Keratolytic Agents - therapeutic use
Male
Microbiological Techniques
Molecular Diagnostic Techniques
nail
Nails - pathology
onychomycosis
Onychomycosis - complications
Onychomycosis - diagnosis
Onychomycosis - drug therapy
Onychomycosis - microbiology
Psoriasis
Psoriasis - complications
Psoriasis - diagnosis
Psoriasis - drug therapy
rhodotorula
Rhodotorula - isolation & purification
Rhodotorula mucilaginosa
Treatment Outcome
yeast
rhodotorula
onychomycosis
infection
Psoriasis
nail
yeast
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Summary:Summary A 38‐year‐old man presented with whitish nail changes on all fingers as the sole symptom. The condition had developed within a few days and led to dystrophy of the proximal part of the nail plates. As microscopic examination of nail scrapings demonstrated budding hyphae and the patient working as a teacher reported frequent use of a wet sponge, antifungal therapy was initiated. Subsequent cultures and molecular typing identified Rhodotorula mucilaginosa (formerly R. rubra). This environmental yeast was repeatedly isolated despite of therapy with itraconazole. As no improvement was achieved and testing of the biological activity of the fungus revealed only marginal keratolytic activity, it was considered as a coloniser of a destructed nail matrix. Finally, a biopsy of the nail bed confirmed the diagnosis of nail psoriasis, which rapidly responded to treatment with acitretin and topical calcipotriol/betamethasone cream. Fungal growth in destructed nails masqueraded the underlying disease and may have triggered the psoriatic nail reaction.
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ISSN:0933-7407
1439-0507
DOI:10.1111/myc.12091