PMC4718227_01
A, Nail lesions before adalimumab injection: nail pitting (arrowheads), leukonychia, oil stains, distal ungual crumbling, and hyperkeratosis (arrow). B, Clinical presentation of Majocchi's granuoloma: multiple erythematous papulonodules developed 1 month after adalimumab injection. C, Microsporum gypseum: fungal hyphae (arrowheads) highlighted with Grocott's Methenamine Silver (GMS) stain (original magnification x400). D, Nail lesions after 12-week terbinafine treatment: almost all hyperkeratotic nails havereturned to normal except for mild nail pitting on a few nails (arrowheads).
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F1
Nail changes including nail pitting, leukonychia, oil stains, distal ungual crumbling, and subungual hyperkeratosis were also found (Figure 1A). These lesions presented as erythematous, mildly tender nodules, and the locations roughly corresponded to the previous tinea corporis sites (Figure 1B). Methenamine Silver (GMS) stains. Microsporum gypseum complex grew in the soft tissue culture (Figure 1C). After 12 weeks of treatment with systemic terbinafine, cutaneous nodules had almost disappeared, and all the nails were almost normal except for minimal pitting (Figure 1D).