An Unusual Presentation of Candidal Onychomycosis: A Case Report

Onychomycosis can present with various manifestations such as subungual hyperkeratosis, onycholysis, and nail plate destruction. Here we present a case of a 61-year-old African male with a known case of type 2 diabetes mellitus on insulin. He worked as a mechanic and presented with nail changes that started four months prior to presentation and worsened over time, mainly affecting the fingernails of bilateral hands. On examination, there was yellowish to greenish discoloration with very extensive hyperkeratosis of skin around the fingers and nails that caused avulsion of nails. Swab and culture showed Candida albicans +3. Nail and skin biopsy showed bacterial colony with fungal hypha. The patient showed marked improvement after receiving oral fluconazole 300 mg weekly for three months.