A case of Sweet's syndrome is reported in a patient with Behçet's disease. This association has not been reported outside Japan. The relationship of the two diseases is discussed.

Candida dubliniensis was first reported in 1995 as a pathogen causing oral candidiasis in patients with AIDS. 1 Although a rare pathogen, it causes disseminated candidiasis, fungemia, fungal keratitis, spondylodiscitis, catheter-related blood stream infections and endocarditis in immunocompromised patients. 2 Thus far, there has been one report of cutaneous abscess caused by C. dubliniensis with uncontrolled diabetes. 2 C. dubliniensis and Candida albicans share many phenotypical characteristics. Therefore, it is difficult to distinguish between these pathogens. Owing to easy access to genetic testing or MALDI-TOF MS, an increasing number of C. dubliniensis infections have been reported. 3 Even in patients in whom C. dubliniensis is isolated and cultured from skin lesions, it is necessary to histopathologically confirm the presence of fungal elements and perform repeated cultures to determine C. dubliniensis as the true pathogen.

Wood's lamp was demonstrated to be useful in three cases of dermatophytoma treated during clinical dermatological practice. Clinical signs of onychomycosis are longitudinal yellow and white striae on the nail plate and are diagnosed by KOH direct microscopic examination. For its treatment, surgical debridement is recommended. Usefulness of the Wood's lamp for diagnosis of tinea capitis caused by Microsporum canis is standard. In the first and second cases, we used Wood's lamp (Woody TM ) to make a clear margin for debridement of onychomycosis. In the third case, onychomycosis was unsuccessfully treated using topical 5% luliconazole nail solution for 1 year and 10 months with yellow nail discoloration. Under Wood's lamp, we were able to distinguish luliconazole crystal staining from onychomycosis. This method is simple and quick, and useful for nail observation in dermatology clinics.

A 57-year-old male patient with > 10-year history of type 2 diabetes presented with a left big toenail deformity and pain. A physical examination revealed a white and yellow-to-brown patch on the nail as well as thickening and ingrowth of the nail plate. The nail plate was opened using nippers, and a fungal culture revealed Trichophyton interdigitale with yellow yeast. The yeast isolate was identified as Kocuria koreensis, a Gram-positive aerobic coccoid with keratinolytic properties that is part of the normal flora of the skin. We created an ex vivo onychomycosis model of T. interdigitale infection of the human nail by placing a sterilized normal nail on the cultured slant. K. koreensis initially spread over the normal nail, and T. interdigitale then penetrated the nail plate. After one year and six months, a spiral ingrown nail developed. A histopathological examination of the spiral revealed onychomycosis with superficial and deep abscesses of Gram-positive cocci infection. We performed PCR from paraffin-embedded material, and the sequences obtained were identical to those of T. interdigitale and K. koreensis. These results suggest that the development of onychomycosis by T. interdigitale is introduced and accelerated by K. koreensis, and the symbiosis of these microorganisms is suspected in the nail. This ex vivo model has a number of limitations. Therefore, further research on co-infected cases is needed to confirm this hypothesis.

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