Local Manifestation of HIV- AIDS

HIV- AIDS is a well known and well documented disease with symptoms that can be systemic and localized. This is a case of a 50 year old male patient who presented with chief complaints of toe pain for 2 weeks. Pertinent positive history of HIV, controlled. Mild erythema on both big toes with loosening of the nail from its proximal attachment. Subungual debris is noticeable. Fingernails can have a similar presentation, just like we did in this case. Treatment includes managing local bacterial skin infection initially and treating fungal infection over time. 

Proximal white subungual onychomycosis has been identified as the most prevalent form of onychomycosis among AIDS patients. It begins under the nail plate proximally and progresses distally. Onychomycosis caused by Candida albicans is more common in the later stages of HIV infections. With regard to tinea pedis, Trichophyton rubrum appears to be the predominant infective agent. Treatment varies, nail samplings are used to confirm the fungal organism. Oral Itraconazole, terbinafine and topical Ciclopirox nail lacquer has been effective in treating these types of nails. Recurrence though seems to be high.