International Journal of Medical Microbiology · Published 2026-06-24 · DOI 10.1016/j.ijmm.2026.151728
Siti N. Kholidah, Agnes S. Siswati, Tri Wibawa
Onychomycosis caused by non-dermatophyte molds (NDMs) is rare, and Chaetomium spp. represents an extremely rare pathogen with fewer than 20 cases reported worldwide. Misdiagnosis frequently leads to treatment failure and relapse. We report the first documented case of Chaetomium spp. onychomycosis from Indonesia: a 29-year-old immunocompetent woman with nail trauma and frequent swimming who presented with dystrophic changes and brownish-black discoloration of multiple toenails and one fingernail. Identification was made by direct microscopy and SDA culture. Antifungal susceptibility testing revealed resistance to itraconazole and ketoconazole, with sensitivity to terbinafine and fluconazole. The patient received a three-month course of topical terbinafine cream (twice daily), 10% salicylic acid, and oral fluconazole (150 mg, increased to 300 mg once weekly). Complete remission was achieved with no recurrence at three months post-treatment. This case, supported by a literature review, underscores the need to consider rare NDM pathogens in refractory nail infections and the critical role of antifungal susceptibility testing in guiding combination therapy.
Abstract from DOAJ. Public domain (CC0 1.0).
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Kholidah, S., Siswati, A., Wibawa, T. (2026). Successful treatment of rare non-dermatophyte onychomycosis caused by Chaetomium spp. with oral fluconazole and topical terbinafine combination – A case report from Indonesia and literature review. International Journal of Medical Microbiology. https://doi.org/10.1016/j.ijmm.2026.151728