Onychomycosis caused by a rare fungal pathogen: A neoscytalidium novaehollandiae case

• Author Details:   
• Nidhi Mihirkumar Bhalodia ^*
• Kajal Parmar
• Mihirkumar J Bhalodia
• Himani Pandya
• Tanuja Javadekar

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This study presents a rare case of onychomycosis caused by non-dermatophytic fungi. A 43-year-old male patient visited the dermatology OPD with complaints of color change of his right fingernails after injury during farming work. The patient’s complaints did not resolve even after one month of treatment with oral itraconazole in a private health setup. So, for further investigation, nail clipping was sent to the Microbiology laboratory at our hospital. Macroscopically, there was a total dystrophy of the nail. It was discolored. Direct microscopic examination of nail scraping with 40% potassium hydroxide, under low light at 40x, revealed septate hyphae. The nail clipping sample was cultured on SDA agar and incubated at 25^°C and at 37^°C. After 3 days of incubation fungal colony appeared. Macroscopically, the fungus was greenish with a powdery consistency, with no reverse pigmentation. Microscopically, phaeoid hyphae were seen with chains of arthroconidia. Based on laboratory evidence, the isolated fungus was diagnosed to be a black fungus, Neoscytalidium novaehollandiae. However, due to some limitations, no further investigation and molecular identification had been done. The patient was provided OPD based treatment with oral terbinafine and ciclopirox nail lacquer. The patient responded to the treatment within 3 months.

Keywords: Onychomycosis, Neoscytalidium novaehollandiae, Terbinafine.