Microsporum audouinii typically causes ectothrix tinea capitis. We describe six pediatric cases with endothrix parasitism and positive Wood's lamp fluorescence. Cultures identified Microsporum audouinii , with additional MALDI-TOF confirmation in a subset. These findings suggest possible variation in hair invasion. Fluorescence reflects infection-associated fluorophores rather than arthroconidial location alone; its coexistence with endothrix parasitism is a plausible interpretation requiring further investigation. Microscopy should be interpreted alongside culture and species identification.
Cryptococcal meningitis is increasingly recognized outside HIV. We report an HIV-negative man with advanced chronic kidney disease and recent corticosteroid exposure who presented with encephalopathy without headache, meningismus, or elevated intracranial pressure. MRI showed leptomeningeal enhancement; CSF cryptococcal antigen was positive despite negative fungal culture and multiplex PCR. Induction with liposomal amphotericin B and high-dose fluconazole was complicated by renal failure requiring hemodialysis. This case highlights diagnostic discordance and treatment challenges in advanced kidney disease.
Nail scabies is rare and may closely mimic onychomycosis, particularly in patients without typical cutaneous lesions. Here we report an 82-year-old Chinese woman initially suspected of having onychomycosis, whereas direct microscopic examination of nail scrapings unexpectedly revealed Sarcoptes scabiei mites together with fungal hyphae in the same microscopic field. Fungal culture yielded yeast subsequently identified as Candida albicans (C. albicans) by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Based on these findings, nail scabies coexisting with C. albicans onychomycosis was diagnosed. The patient was successfully treated with topical crotamiton under occlusion combined with bifonazole cream. This case demonstrates that fungal infection and parasitic infestation may coexist within the same nail unit and highlights the importance of combined parasitological and mycological evaluation in patients with atypical nail dystrophy.
A 7-year-old boy presented with kerion-like inflammatory alopecia. Direct microscopy demonstrated fungal hyphae, and a cultured mould was reported as Aspergillus lentulus by mass spectrometry. Treatment comprised oral terbinafine for 3 months and oral prednisone for 2 months. Fungal examination was negative and Wood lamp examination was normal at 3 months; hair regrowth was gradually recovering at the 6-month follow-up. This case illustrates the need to interpret an unusual mould isolate alongside clinical findings before assigning causation.
