Case Description
A 34-year-old woman presented in our emergency department due to progressive painful swelling around the nail of the right index finger, that had first appeared 30 days prior to the referral. The symptoms occurred immediately after a finger injury. Approximately 2 weeks after the trauma, the patient noticed a greenish discoloration of the nail plate of the affected finger. An empirical antibiotic therapy with amoxicillin/clavulanic acid had been unsuccessful.
On examination, the patient’s vital signs were unremarkable. A distal onycholysis and a greenish discoloration of the entire nail plate of the right index finger, as well as a purulent proximal nail fold were seen (Figure 1).
Onychectomy and drainage of the abscess of the affected finger were performed as the inflammation was progressive despite the previous antibiotic therapy. The microbiological culture revealed a ciprofloxacin-susceptible Citrobacter braakii (C. braakii ) infection and a postoperative antibiotic therapy with ciprofloxacin was therefore prescribed. In the five-day follow up, the patient was symptom-free and the inflammatory markers (WBC, CRP) were within the normal range.
Green nail syndrome (GNS) is a rare condition, usually caused by Pseudomonas aeruginosa [1]. However, other pathogens, such as the rare gram-negative bacillus C. braakii can also be involved in the pathogenesis of this condition [2].
Keywords: Green nail syndrome, onycholysis, onychectomy,Citrobacter braakii