Three cases of Nattrassia mangiferae (Scytalidium dimidiatum) infection in Singapore

• Published in: International journal of dermatology 2002-01, Vol.41 (1), p.53-55
• Main Authors: Goon, Anthony Teik-Jin, Seow, Chew-Swee
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ascomycota; Biological and medical sciences; Dermatomycoses - diagnosis; Dermatomycoses - drug therapy; Dermatomycoses - pathology; Human mycoses; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Mycoses; Mycoses of the skin; Onychomycosis - diagnosis; Onychomycosis - drug therapy; Onychomycosis - pathology; Tropical medicine
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1046/j.0011-9059.2001.01386.x

Case no. 1 A 70‐year‐old Indian man had lateral onycholysis of his left big toe since 1989. Nail scrapings from the left big toenail were negative three times in 1989 and 1990. Fungal cultures from the left big toenail were negative for dermatophyte and nondermatophyte molds in 1990. The condition did not respond to topical itraconazole 1% lotion (prepared by our pharmacy from itraconazole capsules), ketoconazle cream, tolnaftate lotion and nonstaining Castellani paint as well as oral itraconazole 100 mg daily for 4 weeks. In 1993, there was distal onycholysis of the fingernails on the left thumb, left ring and index and right little fingers as well. Once again, the skin scrapings from the finger‐ and toenails were negative. The condition did not respond to topical tolnaftate lotion, clotrimazole 1% lotion, miconazole 1% lotion, thiabendazole 10% lotion and nonstaining Castellani paint. In September 1999, both big toenails had crumbling nail plates and ragged distal edges. Nail scrapings showed the presence of mycelium and the fungal culture result was reported Scytalidium dimidiatum and Fusarium species. The Fusarium was thought to be a nonpathogenic coloniser. He was treated with oral griseofulvin, thiabendazole 10% lotion and nonstaining Castellani paint without much improvement. He was last seen in January 2001. There was still destruction of the nail plate and separation of the nail plate from the nail bed. Case no. 2 A 45‐year‐old Chinese man who worked as a clerk in a cosmetic company was first seen in July 1994 for scaly hyperkeratotic rashes on both soles for 10 years. He had tried using miconazole cream but the problem persisted. Skin scrapings revealed the presence of mycelium and fungal culture result war reported as Hendersonula toruloidea. He was born in Singapore and had never lived overseas. The condition persisted despite 9 weeks of oral griseofulvin 250 mg twice daily and miconazole 2% cream, 3 months of 10% thiabendazole lotion, 2 weeks of oral thiabendazole 500 mg twice daily and ung Whitfield. He subsequently defaulted after the last visit in April 1995, when he was prescribed amorolfine cream. He was seen again in July 1998 for acne vulgaris. His soles were still hyperkeratotic but skin scrapings were not taken. He defaulted again after 3 visits. Case no. 3 A 33‐year‐old Indian man who had been working in a machine assembly line for 12 years presented with an itchy scaly rash on his feet for 3 years and on the hands for 1 year in Nove