CASE REPORT article
Front. Med.
Sec. Dermatology
Pseudomonas aeruginosa and Burkholderia cepacia complex Co-infection in Green Nail Syndrome: A Case Report
Ao Zhang 1
Haixia Kuang 2
Fan Chang 3
Hongxia Li 3
Zhuokun Ran 4
Xinyu Lin 1
1. Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
2. Department of Dermatology, Yestar Plastic Surgery Hospital, Chengdu, China, Chengdu, China
3. Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, China
4. North Sichuan Medical College, Nanchong, China
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Abstract
Green nail syndrome (GNS) is classically characterized by a triad of green nail discoloration, paronychia, and onycholysis. Although Pseudomonas aeruginosa(P. aeruginosa ) is the primary etiologic agent, infections involving co-pathogens are uncommon and pose considerable diagnostic and therapeutic challenges due to the absence of standardized management guidelines. We herein report a rare case of GNS caused by a co-infection with P. aeruginosa and the Burkholderia cepacia complex(BCC) in a woman with a history of manicures and frequent domestic exposure to water and detergents. The diagnosis was confirmed through bacterial culture and antimicrobial susceptibility testing. Targeted therapy involving a combination of oral and topical levofloxacin, guided by the antimicrobial susceptibility profile, resulted in the successful resolution of the infection. This case underscores the critical importance of microbiological identification for guiding effective treatment of non-classical GNS and demonstrates the efficacy of tailored antibiotic regimens in managing complex co-infections.
Summary
Keywords
Antimicrobial therapy, Burkholderiacepacia complex, case report, Co-infection, diagnosis, Green nail syndrome, Pseudomonas aeruginosa
Received
21 November 2025
Accepted
10 February 2026
Copyright
© 2026 Zhang, Kuang, Chang, Li, Ran and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Xinyu Lin
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