Successful treatment of resistant onychomycosis with voriconazole in a liver transplant patient

Onychomycosis is a common chronic fungal infection of the nails caused by dermatophytes, yeasts, and non-dermatophyte filamentous fungi. A relatively high incidence of resistance and treatment failure of onychomycosis to traditional systemic antifungal agents such as terbinafine and itraconazole has been reported. Voriconazole is a novel broad spectrum systemic antifungal that has shown high efficacy against various types of dermatophytes including Trichophyton and Microsporum species in many in vitro and, recently, in two in vivo studies of resistant dermatophytosis. Herein, we report the successful treatment of a resistant case of finger nail onychomycosis by oral voriconazole in a liver transplant patient who failed to respond to traditional systemic antifungals.