# Pseudomonas aeruginosa and Burkholderia cepacia complex co-infection in green nail syndrome: a case report

## TL;DR

A rare case of green nail syndrome caused by two bacteria, Pseudomonas aeruginosa and Burkholderia cepacia complex, was successfully treated with targeted antibiotics.

## Contribution

Reports a rare co-infection in GNS and demonstrates the effectiveness of tailored antibiotic therapy.

## Key findings

- Co-infection with P. aeruginosa and BCC was confirmed through bacterial culture and susceptibility testing.
- Combination therapy with oral and topical levofloxacin resolved the infection effectively.
- Microbiological identification is crucial for managing non-classical GNS cases.

## 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.