<b><i>Candida guilliermondii</i></b> Onychomycosis Involving Fingernails in a Breast Cancer Patient under Docetaxel Chemotherapy

Abstract

Onychomycosis has been shown to have a higher incidence in cancer patients. Nail toxicity is a quite common side effect of anticancer agents. Taxotere&lt;sup&gt;©&lt;/sup&gt; is a chemotherapeutic known to cause great incidence of nail change and has a role in subungual suppuration. We report on a 52-year-old woman with breast cancer admitted in our institution for onycholysis. Because of the stage and histology of breast cancer, neoadjuvant chemotherapy was initiated. The patient received 8 cycles of Taxotere and Adriamycin (AT), and she underwent a modified radical mastectomy. Three months later, the patient developed evidence of onycholysis, involving all the fingernails. We observed the following changes in nails of all the digits in both hands: onycholysis, dystrophy, oedema, and exudate. Nail scraping and purulent discharge were collected and cultured on Sabouraud medium. Physical features of the colonies and biochemical tests (Auxacolor&lt;sup&gt;©&lt;/sup&gt;) revealed &lt;i&gt;Candida guilliermondii&lt;/i&gt; as the sole etiologic agent of onychomycosis. This case details an onycholysis in a breast cancer case successfully managed solely with amorolfine lacquer. This clinical and mycological presentation should alert the clinician to the possibility of onychomycosis induced by docetaxel chemotherapy.

Atypical and Unpredictable Superficial Mycosis Presentations: A Narrative Review

“…Docetaxel chemotherapy administred to breast cancer patient induced Candida guillermondii onycholyse associated to exudate and oedema [80]. (Figure 2)…”

“…Uncommon onychomycosis clinical features such as onycholysis, oedema, and exsudate have been linked to chemotherapy in breast cancers patients [80]. Melanonychia of fungal origin with brown or black pigmentation of the nail unit is a relatively rare clinical sign and can mimic subungual melanoma [145][146][147][148][149].…”

Atypical and Unpredictable Superficial Mycosis Presentations: A Narrative Review

“…Immunosuppressive drugs IL17-inhibitor, tocilizumab, pimecrolimus, and tacrolimus have been linked to tinea incognito [5,10,90]. Chemotherapy Docetaxel chemotherapy administered to breast cancer patients induced Candida guillermondii onycholyse associated with exudate and oedema [91] (Figure 2).…”

“…Uncommon onychomycosis clinical features such as onycholysis, oedema, and exudate have been linked to chemotherapy in breast cancers patients [91]. Melanonychia of fungal origin with brown or black pigmentation of the nail unit is a relatively rare clinical sign and can mimic subungual melanoma [156][157][158][159][160].…”

Tinea Versicolor Disguised as Pityriasis Alba: How to Deal with Confusing Skin Hypopigmentation

“…Numerous hypopigmented patches on the arms and trunk can be compatibles with mycosis fungoides in elderly 13,27,28 . On the other hand, pityriasis alba should be considered among children, this condition is characterized by hypopigmented patches that usually affect the face.…”