A 48-year-old-man presented to the dermatology clinic with a whitish discoloration and hyperkeratosis of the first toenail that had extended from the proximal to the distal nail during the past month (Panel A). Microscopic examination of the isolate stained with cotton blue revealed pyriform microconidia that had a “birds on a wire” appearance at the sides of the hyphae (Panel B). #Clinical #IM #InfectiousDisease #Onychomycosis #TrichophytonRubrum #HIV #RapidProgression #NEJM
