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

Rhodotorula mucilaginosaand Candida glabratahave emerged as potential pathogens, particularly in immunosuppressed hosts. This study aimed to present a case of coinfection of Candida glabrataand Rhodotorula mucilaginosain a 35-year-old immunosuppressed female with onychomycosis on the first and second left toenails.

Causative agents were identified according tomorphology, microscopic studies, culture, and DNA molecular analysis. Candida glabrata demonstrated high minimum inhibitory concentrations against the tested antifungalsexcept itraconazole. Moreover, Rhodotorulamucilaginosahadshownlow minimum inhibitory concentrationsagainst 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.

Clinical improvement was noted in the patient's clinical examination after ten months. Informationabout the increasing resistance to antifungal agents helps decide antifungal prophylaxis and select the empirical therapy for cancer patients.