Lee Kyung Jin, Lee Young Bok, Lee Jun Young, Cho Baik Kee, Choi Jong Soo, Park Hyun Jeong
Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea.
Ann Dermatol. 2011 Sep;23 Suppl 1(Suppl 1):S11-5. doi: 10.5021/ad.2011.23.S1.S11. Epub 2011 Sep 30.
A 58-year-old man presented with whitish patches on both great toenails for four weeks prior to visiting our hospital; the patches spread rapidly to other finger- and toe-nails. Prior to presentation, the patient had been diagnosed with idiopathic thrombocytopenic purpura two months ago and Kaposi's sarcoma three weeks ago. The patient was treated with human immunoglobulin for five days, and then received prednisolone 40 mg bid. Serology showed that the patient was negative for HIV and results of other laboratory tests were normal. The KOH slide preparation of the nail scraping showed long septated hyphae and numerous arthrospores. The fungus culture revealed whitish downy colonies on the front side and wine-red reverse pigmentation on Sabouraud's dextrose agar. Trichophyton rubrum was isolated on fungus culture and slide culture. The internal transcribed space (ITS) regions of ribosomal DNA of the cultured fungus were identical to Trichophyton rubrum. Proximal subungual onychomycosis (PSO) is the rarest form of onychomycosis. PSO initially presents as whitish patch(es) on the proximal side of the nail plate(s). Because PSO shows whitish to yellowish patches on the nail plate, the result of KOH examination of nail scrapings from the nail plate is almost always negative. Herein, we report on a case of multiple PSO in a patient with classic Kaposi sarcoma and suggest a method for easy KOH scraping on PSO.
一名58岁男性在就诊我院前四周，双侧大脚趾甲出现白色斑块；这些斑块迅速蔓延至其他手指和脚趾甲。就诊前两个月，该患者被诊断为特发性血小板减少性紫癜，三周前被诊断为卡波西肉瘤。患者接受了五天的人免疫球蛋白治疗，随后接受泼尼松龙40mg，每日两次。血清学检查显示患者HIV阴性，其他实验室检查结果正常。指甲刮屑的氢氧化钾玻片制备显示有长的分隔菌丝和大量关节孢子。真菌培养在沙氏葡萄糖琼脂上显示正面有白色绒毛状菌落，背面有酒红色色素沉着。真菌培养和玻片培养分离出红色毛癣菌。培养真菌的核糖体DNA内部转录间隔区（ITS）与红色毛癣菌相同。近端甲下甲真菌病（PSO）是甲真菌病最罕见的形式。PSO最初表现为甲板近端的白色斑块。由于PSO在甲板上表现为白色至黄色斑块，从甲板刮取的指甲屑进行氢氧化钾检查结果几乎总是阴性。在此，我们报告一例经典卡波西肉瘤患者发生多发性PSO的病例，并提出一种针对PSO的简易氢氧化钾刮屑方法。
