Proximal White Onychomycosis in an Immunocompetent Patient: A Case Report

Objective: Onychomycosis is a diagnosis of fungal organisms in the nail unit. It frequently occurs in both the immunocompetent and immunocompromised patient. A variant of onychomycosis is proxiaml onychomycosis that occurs on the most proximal aspect of the nail. Proximal onychomycosis is known to be commonly associated with immunocompromised status. Study Design: A case report of a veteran who presented a dermatology clinic with complaint of solitary nail discoloration that was recalcitrant to over-the-counter therapy including topical hydrogen peroxide and foot soaks without improvement. Results and Conclusions: This individual case report demonstrates that pedal proximal onychomycosis can be associated with non-dermatophyte organisms, identified as Fusarium species, in immunocompetent individuals. The finding of pedal proximal onychomycosis caused by a Fusarium non-dermatophytic mold has not been reported. The veteran was successfully cured of the condition with treatment via oral terbinafine for a ninety-day course while monitoring patient’s liver function test for any complications.