Green Nail Syndrome Treated with Ozenoxacin: Two Case Reports.

Green nail syndrome (GNS) is a persistent greenish pigmentation of the nail plate, originally described in 1944 by Goldman and Fox, due to infection. Recently, pulmonary co-infection of and spp. has been described in patients with cystic fibrosis. is a multidrug-resistant (MDR) pathogen involved in lung and soft tissue skin infections. Both and are mainly found in humid environments or in water. There are no recognized co-infections due to and in the skin and appendages. We describe two cases of GNS, the first due to associated with ; the other due to MDR , both successfully treated with topical ozenoxacin 1% cream daily for 12 weeks. The clinical management of GNS can be confusing, especially when the bacterial culture result is inconsistent or when non- bacteria are isolated. In our case, due to the co-infection of and spp., local treatment with ozenoxacin - the first nonfluorinated quinolone - could be a safe and effective treatment in case of MDR nail infections. Further studies are required to evaluate clinical isolation from nail infections and the co-presence of and .