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Recurrent proximal white subungual onychomycosis associated with a defect of the polymorphonuclear chemotaxis
1Department of Dermatology, Ospedale San Paolo, University of Milan, Italy.
Abstract:
Proximal white subungual onychomycosis (PWSO) is a rare form of nail infection that occurs almost exclusively in immunocompromised patients. Initially, in several reports, PWSO was described in ARC and AIDS patients. Later this pattern of onychomycosis was observed in patients with renal transplants, who received immunosuppressive therapy, and recently in a woman with active systemic lupus erythematosus (SLE) treated with systemic steroid therapy. We report a case of recurrent PWSO in a woman affected by a defect of polymorphonuclear chemotaxis. The association between PWSO and a defect of neutrophil chemotaxis, not yet described in the literature, suggests a point of discussion about the role of polymorphonuclear leucocyte functions in the defense mechanisms of the host affected by dermatophytosis. In this report the close association between PWSO and an immunocompromised condition is once again described. For this reason the authors emphasize the importance of investigating the common and uncommon causes of immunodeficiency in all patients affected by PWSO.
Insights
Proximal white subungual onychomycosis (PWSO), a rare nail infection, predominantly affects immunocompromised individuals. This case highlights a novel association with neutrophil chemotaxis defects, underscoring the need to investigate immunodeficiency in PWSO patients.
Area of Science:
- Dermatology
- Immunology
- Mycology
Background:
- Proximal white subungual onychomycosis (PWSO) is a rare nail fungal infection.
- PWSO typically occurs in immunocompromised patients, including those with ARC, AIDS, renal transplants, and systemic lupus erythematosus (SLE).
Observation:
- This report details a case of recurrent PWSO in a woman with a defect in polymorphonuclear chemotaxis.
- This association between PWSO and neutrophil chemotaxis defect is previously undescribed in medical literature.
Findings:
- The case demonstrates a strong link between PWSO and an underlying immunodeficient state.
- Neutrophil dysfunction may play a role in the host's defense against dermatophytosis, specifically in PWSO development.
Implications:
- The findings suggest that defects in neutrophil function should be considered in patients with PWSO.
- Investigating both common and rare causes of immunodeficiency is crucial for managing PWSO patients effectively.