Scopulariopsis brevicaulis Nail Infection Is Hard to Clear

Scopulariopsis brevicaulis is a nondermatophyte mold that is an uncommon primary cause of onychomycosis. This paper describes the cases of six patients with chronic Scopulariopsis infection involving at least one great toenail. Four patients had distal subungual onychomycosis (DSO), and two had total dystrophic onychomycosis with periungual inflammation.

Cultures for Scopulariopsis were positive on three consecutive samples from each patient. Samples from two patients also grew Trichophyton rubrum and T. interdigitale. All patients were treated with chemical avulsion of the nail using 40% urea ointment and with an oral antifungal drug; three patients received four pulses of itraconazole at 400 mg per day for one week per month, and three rec…