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Nakamura T, Yamauchi M, Sonoda S, Aharen D, Ikemura M, Kohagura K, Kusunose K. Green Nails, Red Alert: An Unusual Exit site infection Presentation. Perit Dial Int 2024:8968608241234529. [PMID: 38445494 DOI: 10.1177/08968608241234529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Green nail syndrome is an infectious nail disorder caused most commonly by Pseudomonas aeruginosa. We report a rare case of peritoneal dialysis (PD) exit site infection (ESI) accompanied by P. aeruginosa-associated green nail syndrome. The patient was treated with oral and topical antibiotics without the need for PD catheter removal. We aim to emphasise the importance of nail assessment for ESI in patients undergoing PD.
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Affiliation(s)
- Takuto Nakamura
- Department of Internal Medicine, Nishizaki Hospital, Okinawa, Japan
| | - Marino Yamauchi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shinichiro Sonoda
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Daigo Aharen
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masaki Ikemura
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Department of Nephrology, Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Cosio T, Petruccelli R, Gaziano R, Fontana C, Favaro M, Zampini P, Pistoia ES, Diluvio L, Lozzi F, Bianchi L, Campione E. Green Nail Syndrome Treated with Ozenoxacin: Two Case Reports. Case Rep Dermatol 2023; 15:217-224. [PMID: 38023344 PMCID: PMC10653707 DOI: 10.1159/000533923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Green nail syndrome (GNS) is a persistent greenish pigmentation of the nail plate, originally described in 1944 by Goldman and Fox, due to Pseudomonas aeruginosa infection. Recently, pulmonary co-infection of P. aeruginosa and Achromobacter spp. has been described in patients with cystic fibrosis. Achromobacter xylosoxidans is a multidrug-resistant (MDR) pathogen involved in lung and soft tissue skin infections. Both Achromobacter xylosoxidans and P. aeruginosa are mainly found in humid environments or in water. There are no recognized co-infections due to P. aeruginosa and A. xylosoxidans in the skin and appendages. We describe two cases of GNS, the first due to P. aeruginosa associated with Achromobacter xylosoxidans; the other due to MDR P. aeruginosa, both successfully treated with topical ozenoxacin 1% cream daily for 12 weeks. The clinical management of GNS can be confusing, especially when the bacterial culture result is inconsistent or when non-Pseudomonas bacteria are isolated. In our case, due to the co-infection of P. aeruginosa and Achromobacter spp., local treatment with ozenoxacin - the first nonfluorinated quinolone - could be a safe and effective treatment in case of MDR nail infections. Further studies are required to evaluate clinical isolation from nail infections and the co-presence of P. aeruginosa and A. xylosoxidans.
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Affiliation(s)
- Terenzio Cosio
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- PhD course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Microbiology Section, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Roberta Gaziano
- Department of Experimental Medicine, “Tor Vergata” University, Rome, Italy
| | - Carla Fontana
- National Institute for Infectious Diseases (INMI) L. Spallanzani, IRCCS, Rome, Italy
| | - Marco Favaro
- Department of Experimental Medicine, “Tor Vergata” University, Rome, Italy
| | - Paola Zampini
- PhD course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Microbiology Section, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Laura Diluvio
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Flavia Lozzi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Bae Y, Lee GM, Sim JH, Lee S, Lee SY, Park YL. Green nail syndrome treated with the application of tobramycin eye drop. Ann Dermatol 2014; 26:514-6. [PMID: 25143684 PMCID: PMC4135110 DOI: 10.5021/ad.2014.26.4.514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/25/2012] [Accepted: 08/26/2012] [Indexed: 11/25/2022] Open
Abstract
Green nail syndrome (chromonychia) is a nail disorder characterized by onycholysis and green-black discoloration of the nail bed. This condition is often associated with chronic paronychia. Pseudomonas aeruginosa is the most commonly identified organism in cultures from the affected area. Despite the various treatment options available, removal of the nail is still necessary in many cases. A 35-year-old man presented with dark-greenish discoloration of the nail plate and onycholysis on the left thumbnail. He had been treated with oral antifungal and antibiotic agents for several months; however, the lesion showed no improvement. The diagnosis of green nail syndrome was established after a positive bacterial culture, and on the basis of the antibiotic sensitivity test result, tobramycin eye drop (Tobrex®) was then prescribed. Three weeks later, the nail discoloration almost vanished but the onycholysis remained. Herein, we recommend the application of tobramycin eye drop as an easy and safe treatment option for green nail syndrome.
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Affiliation(s)
- Youin Bae
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Gang Mo Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Hoon Sim
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sanghoon Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sung Yul Lee
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Müller S, Ebnöther M, Itin P. Green Nail Syndrome (Pseudomonas aeruginosa Nail Infection): Two Cases Successfully Treated with Topical Nadifloxacin, an Acne Medication. Case Rep Dermatol 2014; 6:180-4. [PMID: 25202260 PMCID: PMC4152926 DOI: 10.1159/000365863] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Green nail syndrome (GNS) caused by Pseudomonas aeruginosa is the most common bacterial nail infection. The treatment of GNS is challenging in many cases and recommendations based on clinical trials are lacking. We report two cases with GNS successfully treated with off-label use of topical nadifloxacin, a fluoroquinolone approved for acne and bacterial skin infections in some countries.
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Affiliation(s)
- Simon Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Myriam Ebnöther
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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