A Case of Candida Paronychia·Onychia of a Toe Following Bacterial Paronychia

We report the case of a 78-year-old housewife with candida paronychia·onychia of a toe. The patient has suffered for a number of years from bronchial asthma. and has occasionally been intravenously injected with corticosteroid. On June 10, 1995, she visited our department because she developed erythema with slight swelling and dull pain on the nail fold of her left big toe. During the month prior to her visit, she was treated with antibiotics for hemoptysis, and few weeks later, the tip of the left big toe became diffusely swollen. She noticed an increase in pain, although sharp pain lessened spontaneously after the wound discharged pus three or four days before she visited us. The toe exhibited slight erythema and swelling with dried pustules. Marked exfoliative scales were present in the nail cuticle and the nail glove. Numerous fungal elements of hyphae and grape-shaped spores were detected in the scales and nail plates of the lesion by a direct examination using the KOH method. Organisms isolated from the lesions were identified as Candida albicans serotype A, although no bacteria was cultured. The leisons completely disappeared after 7 weeks therapy with topical application of an antifungal reagent.To our knowledge, only 4 cases of candida paronychia·onychia of the toe have been reported in Japan. We suspect our case to have been complicated with bacterial paronychia.