抗真菌薬の外用療法が奏効したCandida guilliermondiiによるカンジダ性爪囲爪炎

・ステロイド長期内服中の高齢女性に発症したカンジダ性爪囲爪炎から，比較的まれなCandida guilliermondii（C. guilliermondii）が検出された症例を経験した．

・カンジダによる爪囲炎は日常の皮膚科診療でしばしば遭遇するが，ありふれた疾患であるため原因菌種が同定されないことが多い．

・カンジダ性爪囲爪炎の治療ガイドラインではイトラコナゾール内服が第1選択であるが，抗真菌薬による外用療法は安全かつ有効であり，罹患期間が長期化する傾向があるものの，高齢者や内服治療が困難な症例に考慮すべきである．

（「症例のポイント」より）

　

Successful treatment with topical antifungal therapy in a case of Candida onychomycosis caused by Candida guilliermondii

　

Takahashi, Hidenori1）Oyama, Noritaka2）Hasegawa, Minoru2） 1）Department of Dermatology, JCHO Fukui Katsuyama General Hospital 2）Department of Dermatology, University of Fukui

　

Cutaneous Candidosis is a diverse and heterogeneous group of disease, approximately more than 50％ of whom are caused by Candida (C.)albicans. The ordinary diagnostic process and treatment regimen mostly ignore the potential importance for identification of Candida species and susceptibility to the drug. However, it may properly guide dermatologists to treat with oral antifungal drugs or empirical management, particularly in cases with non-C. albicans Candida and drug-resistant species. We herein present a Japanese elderly female with Candida onychomycosis of the ring finger during a long-term use of systemic steroid for ulcerative colitis and rheumatoid arthritis. The fungal culture and subsequent matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)identified C. guilliermondii, an uncommon pathogen causing persisted superficial candidiasis and deep-seated infections in immunocompromised hosts. Although oral itraconazole is the first-line therapy for Candida onychomycosis, she was treated with topical luliconazole cream and obtained satisfactory results at 4-months of treatment. We revisit and discuss about the clinical benefit of Candida species identification and topical antifungal agents in Candida onychomycosis with complicated medical backgrounds in elderly.