Onychomycosis caused by Aspergillus subramanianii

Abstract

We describe a case of a 23-year-old female patient with no apparent underlying diseases. She showed a discoloration of the proximal portion of the left big toenail with paronychia. Direct microscopy revealed septate hyphae with conidiophores, and a periodic acid-Schiff-stained nail specimen revealed septate hyphae branching at angles of approximately 45°. On the basis of phylogenetic analysis, we finally arrived at the diagnosis of ungual aspergillosis caused by Aspergillus subramanianii. After p.o. administration of terbinafine and topical application of 10% efinaconazole solution, the disease resolved in 6 months. A. subramanianii is one of the new species in the genus Aspergillus section Circumdati. Reported clinical isolates have been isolated from lung tissue, wounds and feet. This is the first documented case of onychomycosis caused by A. subramanianii. Onychomycosis due to Aspergillus species is uncommon. We summarized the reported cases of ungual aspergillosis in Japan.

Non-dermatophyte Mould Onychomycosis in Japan

“…Molecular techniques are useful for the rapid identification of etiological fungi. Moreover, a phylogenetic analysis can reveal uncommon and emerging pathogenic fungi from nail samples 9,10) . The genomic regions that are mostly used for the diagnosis include the internal transcribed spacer (ITS) 1, ITS2, and β -tubulin.…”

“…1a). A. flavus 14) , A. fumigatus, A. ochraceus, and A. subramanianii 9) caused invasive aspergillosis. Patients infected with these fungi presented a rare clinical type of proximal subungual onychomycosis (43%, 3/7) on the toenails (71%, 5/7) (Fig.…”

“…Fig.19,15) . (a) A 47-year-old healthy female nurse presented with melanonychia on her right middle fingernail.…”

Respiratory Failure With Aspergillus submaranianii and Lymphoplasmacystic Vasculitis

“… 2 The additional isolate was found in Japan in a patient with onychomycosis after an earthquake evacuation. 3 …”

“…2 The additional isolate was found in Japan in a patient with onychomycosis after an earthquake evacuation. 3 Lymphoplasmacytic vasculitis is a histopathological finding most associated with IgG subclass 4-related diseases, of which autoimmune pancreatitis is pathognomonic but many organs can be affected. Diagnosis requires the identification of IgG4-positive plasma cells within affected tissues.…”