Onychomycosis Caused by Aspergillus in a Patient with Leprosy: A Case Report

Aspergillus spp., one of the most common nondermatophyte molds (NDMs) that cause onychomycosis, are saprophytic fungi that can act as zoonotic agents and cause various health issues, including onychomycosis, in humans. Predisposing factors for onychomycosis include nail trauma, immunosuppression, and occupation. Nails in patients with leprosy are prone to change and develop onychomycosis due to unrecognized trauma to the nail area. Here, we report the case of a 25-year-old woman with 2-month history of white patches in fingernails and toenails, which were also brittle and damaged. She was a veterinarian who had frequent, direct interaction with animals, particularly dogs and cats. She denied trauma prior to the manifestation of symptoms and was undergoing leprosy treatment, including corticosteroids for leprosy reactions. Examination with potassium hydroxide revealed hyphae, and the nail culture revealed growth of fungal colonies with the characteristics of A. flavus. She received four cycles of itraconazole at 400 mg/day. Two of the three afflicted nails showed complete cure, whereas one nail showed mycologic cure. A. flavus is frequently found in animals, including dogs and cats and might have been a source of Aspergillus transmission, suggesting the patient's occupation and immunosuppression as risk factors for onychomycosis. Onychomycosis due to Aspergillus, particularly A. flavus, responds well to itraconazole pulse monotherapy.