Remah Alzayyat*, Abdullah aljaflan and Sarah Albreiki
Background: Onychomycosis (OM) is a chronic nail disorder frequently encountered by healthcare providers. Yeasts account for only 2-10% of fungal nail infections. Predisposing factors for OM include trauma, diabetes, immunosuppression, nail psoriasis, old age, exposure to humid environments, occupations involving frequent travel, and handwashing.
Objective: To report a rare case of Candida albicans nail infection in an immunocompetent 22-year-old Saudi female, a condition that is not commonly seen.
Case Presentation: We present a case of a 22-year-old, otherwise healthy, Saudi female who presented to our dermatology clinic with a nail lesion lasting nearly two months. Physical examination revealed single, unilateral total nail dystrophy with subungual hyperkeratosis of the ring finger, associated with a hyperpigmented plaque with fine white scales. Surprisingly, culture isolated Candida albicans, leading us to initiate treatment with itraconazole, dosed as 200 mg BID for one week, followed by a three-week break, in a pulse-dosing regimen. The nail showed dramatic improvement with this regimen during each monthly visit.
Conclusion: Candida onychomycosis rarely occurs in immunocompetent adults. Proper history and physical examination are essential for making the correct diagnosis. Culture is the definitive method for identifying the causative microorganism. Nail hygiene and antifungal treatments are the mainstays of treatment.
