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