An Unusual Case of Cycloheximide-Resistant Aspergillus Candidus Onychomycosis

Abstract

Background: Onychomycosis, a common fungal infection of the nails, poses significant challenges in diagnosis and management, particularly with emerging opportunistic pathogens like Aspergillus candidus. We present a case of onychomycosis caused by cycloheximide-resistant A. candidus, underscoring the importance of heightened awareness and surveillance among medical mycology teams. Case presentation: A 63-year-old male with a history of chronic smoking and type 2 diabetes mellitus presented with lateral onycholysis of the right big toenail. Microscopic examination and culture revealed A. candidus, resistant to cycloheximide. Treatment involved chemical avulsion of the nail plate, systemic terbinafine, and topical amorolfine nail lacquer. Conclusion: Our report signifies the emergence of A. candidus as a significant causative agent of onychomycosis, particularly in individuals with predisposing comorbidities. Vigilance among medical mycology teams is crucial for tracking evolving epidemic trends and optimizing treatment approaches. Continued surveillance and reporting are essential for advancing our understanding and management of fungal infections in clinical practice.