Textbook case of onychomycosis caused by Scopulariopsis brevicaulis
Abstract
Scopulariopsis brevicaulis is commonly found in soil and on surfaces exposed to the air, attacking a great variety of organic materials growing on substances rich in protein. This particular species, S. brevicaulis, is well recognized as the most common etiologic agent of non-dermatophyte onychomycosis in temperate zones.1 Antifungal therapy with itraconazole and terbinafine is less effective than that in dermatophytosis.2 We herein report a definitive case of onychomycosis caused by S. brevicaulis. A 44-year-old female homemaker with no particular history or underlying disease, including tinea pedis and tinea unguium, noticed brown discoloration of her right big toenail 3 years previously. Upon presentation in February 2019, the nail was thickened (2.3 mm) with a cinnamon-colored surface. The clinical subtype was distal and lateral subungual onychomycosis (Figure 1a). Direct microscopy of a nail specimen revealed numerous thick-walled oval- or lemon-shaped conidia with a truncated base (Figure 1c). Histopathologically, periodic acid–Schiff staining showed septate hyphae and conidia (Figure 1d). Plate culture on Sabouraud's dextrose agar at 25°C yielded a buff-colored, powdery colony with radial grooves after 4 weeks. The colony reverse was a pale yellow-brown (Figure 1e). Slide cultures revealed verticillate annellidic conidiophores with basipetal conidial chains (Figure 1f). The base sequence of the internal transcribed spacer region of the isolate's rRNA gene showed 99%…
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