1. A clinical entity called proximal white onychomycosis has been described in patients with one of the following conditions:
a) Nail-patella syndrome
b) Yellow nail syndrome
c) AIDS
d) Plummer-Vinson syndrome
e) Laugier-Hunziker syndrome
2. This patient has anesthesia and paresthesia of the face near the ulcer. Which one of the following has been causally associated with this disorder?
a) Epidemic encephalitis
b) Leishmaniasis
c) Blastomycosis
d) AIDS
e) Basal cell carcinoma
1. A clinical entity called proximal white onychomycosis has been described in patients with one of the following conditions:
c) AIDS
A combination of proximal subungual onychomycosis and white onychomycosis caused by Trichophyton rubrum has been reported in patients with AIDS. This is an unusual picture since the two types of fungal infection do not occur together and white superficial onychomycosis is usually due to Trichophyton mentagrophytes. Patients wih nail-patella syndrome do not usually get onychomycosis. The yellow nail syndrome shows absent cuticles and Laugier-Hunziker syndrome shows melanonychia. Plummer-Vinson syndrome has associated koilonychia. Note: This nail patch is a dermatophytoma; it has short, thick hyphae in large numbers (a fungal “abscess”) and responds poorly to most topical and systemic antifungals, usually requiring partial or total nail avulsion plus antifungals.
References
Moreno-Coutiño G, Arenas R, Reyes-Terán G. Clinical manifestation of onychomycosis in HIV/AIDS: a review of 280 Mexican cases. Indian J Dermatol. 2011;56(1):120-121. doi:10.4103/0019-5154.77577
Sigurgeirsson B. Prognostic factors for cure following treatment of onychomycosis. J Eur Acad Dermatol Venereol. 2010;24(6):679-684. doi:10.1111/j.1468-3083.2009.03487.x
Choudhary SV, Koley S, Mallick S, Bose S, Basak S. Proximal subungual oncyhomycocis caused by Aspergillus flavus in a HIV-positive patient. Indian J Dermatol Venereol Leprol. 2009;75(4):410-412. doi:10.4103/0378-6323.53152
2. This patient has anesthesia and paresthesia of the face near the ulcer. Which one of the following has been causally associated with this disorder?
a) Epidemic encephalitis
Patients often present with a history of several to many biopsies to rule out cancer. Trigeminal trophic syndrome is characterized by the triad of trigeminal anesthesia, facial paresthesia, and erosion of the ala nasi. This syndrome follows sensory impairment in the trigeminal area, with the majority of ulcers occurring after surgical destruction of the gasserian ganglion as therapy for trigeminal neuralgia. A similar presentation has been reported following epidemic encephalitis (“post-encephalitic trophic ulcer”). This syndrome is also associated with trigeminal neuritis of leprosy. Good long-term results may occur when innervated flaps from the unaffected side of the midline are used to cover the defects. Basal cell carcinoma is not a feature. A helpful acronym for trigeminal trophic syndrome: trigeminal Anesthesia, trigeminal, Paresthesia, Erosion of the ala nasi (APE).
References
Curtis AR, Oaklander AL, Johnson A, Yosipovitch G. Trigeminal trophic syndrome from stroke: an under-recognized central neuropathic itch syndrome. Am J Clin Dermatol. 2012;13(2):125-128.
doi:10.2165/11594060-000000000-00000
Walling HW, Schulz KK. Trigeminal trophic syndrome: improvement with trolamine/sodium alginate-containing topical emulsion. J Am Acad Dermatol. 2009;61(1):160-161. doi:10.1016/j.jaad.2008.11.909
Willis MW, Mobley SR. Trigeminal trophic syndrome. Ear Nose Throat J. 2009;88(3):827.
