Coinfection of Toenail Onychomycosis Caused by Rhodotorula mucilaginosa and Candida glabrata in an Immunocompromised Adult: A Case Report and Literature Review

Abstract

Background: Rhodotorula mucilaginosa and Candida glabrata have emerged as potential pathogens, particularly in immunosuppressed hosts. This study aimed to present a case of coinfection of Candida glabrata and Rhodotorula mucilaginosa in a 35-year-old immunosuppressed female with onychomycosis on the first and second left toenails. Cases Report: Causative agents were identified according to morphology, microscopic studies, culture, and DNA molecular analysis. Candida glabrata demonstrated high minimum inhibitory concentrations against the tested antifungals except itraconazole. Moreover, Rhodotorula mucilaginosa had shown low minimum inhibitory concentrations against clotrimazole and ketoconazole at a dilution of 0.25 μg/ml. Itraconazole is administered at 200 mg twice daily for one week for toenails and as pulse treatment (for one week a month) at 5 mg/kg daily with topical clotrimazole. Conclusion: Clinical improvement was noted in the patient's clinical examination after ten months. Information about the increasing resistance to antifungal agents helps decide antifungal prophylaxis and select the empirical therapy for cancer patients.

Keywords

• onychomycosis, rhodotorula mucilaginosa, candida glabrata, coinfection, drug resistance, antifungal agents