Congenital Cutaneous Candidiasis with Nail Involvement

A full-term male infant was born via spontaneous vaginal delivery to a 27-year-old woman with a history of mild thrombocytopenia during pregnancy. Immediately after birth, he showed a diffuse erythematous maculopapular rash and desquamation with few pustules (Figure, A and B) and no evidence of oral thrush or involvement of the perigenital area. We excluded an intrauterine viral infection through blood tests and viral cultures from skin lesions. A few days later, he showed onychodystrophy of all nails (Figure, C), characterized by proximal elevation of the fingernail plates with yellow–white hyperkeratotic bands associated with the completely resolution of skin rash. The mother referred to a history of vaginal candidiasis during pregnancy, which had not been reported earlier. We performed a nail plate scraping for direct microscopy and culture. Potassium hydroxide 40% mount revealed pseudohyphae and budding yeast cells. The sample was inoculated onto Sabouraud chloramphenicol agar and CHROMagar Candida medium, where it formed, respectively, creamy gray and green colonies. Species identification by matrix-assisted laser desorption/ionization-time of flight confirmed Candida albicans. Given that the infant was a well-appearing baby born at term without systemic symptoms, we decided for less-invasive management, as previously reported, 1 Colantonio S. Hedin E. Li H.O. Gavigan G. Management of congenital cutaneous candidiasis in a healthy term baby: a case report. SAGE Open Med Case Rep. 2019; 7 (2050313X19876707) PubMed Google Scholar with topical nystatin 100 000 units/g cream 4 times per day until all lesions resolved (Figure, D). The patient’s parents provided written permission for publication of this case report and associated images.