Onychomycosis caused by Syncephalastrum species in a patient with Crohn's Disease in Iraq: A case report.

BACKGROUND: Onychomycosis is one of the most common nail disorders worldwide and is predominantly caused by dermatophytes; however, infections caused by non-dermatophyte molds are increasingly recognized as important causes of nail disease. CASE PRESENTATION: We present a case of a 41-year-old male from Duhok, Iraq, with a 15-year history of Crohn's Disease. He presented with progressive discoloration, nail thickening, nail deformity, pain while walking and brittleness of the affected nail that had persisted for several months. He was diagnosed with onychomycosis due to Syncephalastrum species, confirmed by KOH microscopy and characteristic culture morphology. Molecular confirmation was not available to identify to the species level. The fungus was sensitive to itraconazole, nystatin, clotrimazole, amphotericin B, miconazole, and ketoconazole, but showed resistance to fluconazole and voriconazole. He was successfully treated using IV amphotericin B, topical clotrimazole, and nail surgery. CONCLUSIONS: This case demonstrates that Syncephalastrum species can cause clinically significant onychomycosis and should not automatically be dismissed as laboratory contaminants. A combination of clinical assessment, direct microscopy, culture-based identification, and antifungal susceptibility testing is essential for establishing diagnosis and guiding appropriate management.