{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:15:52Z","timestamp":1784031352382,"version":"3.55.0"},"reference-count":8,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    Green nail syndrome (GNS) is classically characterized by a triad of green nail discoloration, paronychia, and onycholysis. Although\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    (\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    ) 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\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    and the\n                    <jats:italic>Burkholderia cepacia<\/jats:italic>\n                    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.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1751352","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T05:27:51Z","timestamp":1771824471000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Pseudomonas aeruginosa and Burkholderia cepacia complex co-infection in green nail syndrome: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Ao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Affiliated Hospital of Southwest Medical University","place":["Luzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixia","family":"Kuang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Yestar Plastic Surgery Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuokun","family":"Ran","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, North Sichuan Medical College","place":["Nanchong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Affiliated Hospital of Southwest Medical University","place":["Luzhou, China"]},{"name":"Department of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.jaad.2020.06.087","article-title":"Appending the appendages: new perspectives on netherton syndrome and green nail syndrome","volume":"83","author":"Heymann","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1097\/QCO.0000000000000717","article-title":"Skin manifestations of Pseudomonas aeruginosa infections","volume":"34","author":"Spernovasilis","year":"2021","journal-title":"Curr Opin Infect Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e464","DOI":"10.1111\/jdv.17224","article-title":"Dermoscopic patterns of green nail syndrome","volume":"35","author":"Ohn","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"991918","DOI":"10.3389\/fmed.2022.991918","article-title":"Case report: novel use of the conventional method\u2014chemical nail avulsion may be effective for treatment of green nail syndrome","volume":"9","author":"Yu","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e36","DOI":"10.1590\/S1678-9946202264036","article-title":"Diabetic foot infection caused by bacteria of the Burkholderia cepacia complex: report of an unusual case and a scoping literature review","volume":"64","author":"Paes Leme","year":"2022","journal-title":"Rev Inst Med Trop Sao Paulo"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e2021093","DOI":"10.5826\/dpc.1104a93","article-title":"Dermoscopy of green nail syndrome: the \"green aurora sign\"","volume":"11","author":"Dominguez-Santas","year":"2021","journal-title":"Dermatol Pract Concept"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.jinf.2018.07.006","article-title":"Burkholderia cepacia complex infections: more complex than the bacterium name suggest","volume":"77","author":"Sfeir","year":"2018","journal-title":"J Infect"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e00139","DOI":"10.1128\/CMR.00139-19","article-title":"Burkholderia cepacia complex bacteria: a feared contamination risk in water-based pharmaceutical products","volume":"33","author":"Tavares","year":"2020","journal-title":"Clin Microbiol Rev"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1751352\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T05:27:52Z","timestamp":1771824472000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1751352\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":8,"alternative-id":["10.3389\/fmed.2026.1751352"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1751352","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,23]]},"article-number":"1751352"}}