Chronic mucocutaneous candidiasis (CMC)
C. Restart daily oral itraconazole
The key to the correct diagnosis is recognition that recurrent fungal infections of the oropharynx, skin, and nails are characteristic of CMC. Choices A and B are incorrect because antibiotics and steroid creams are not treatments for candidiasis and may worsen this condition. Although terbinafine (choice D) is an antifungal medication, it is not first-line therapy for CMC.
Chronic mucocutaneous candidiasis is a primary immunodeficiency disorder characterized by persistent or recurrent noninvasive infections of the skin, nails, oral cavity, and genital mucosa with Candida species, typically C albicans.1
The differential diagnosis of CMC includes other T-cell deficiency diseases that cause chronic candidiasis such as HIV, severe combined immunodeficiency, CARD9 (caspase recruitment domain-containing protein 9) deficiency, CD25 deficiency, and hyperimmunoglobulin E syndrome. Unlike CMC, these conditions are typically associated with invasive Candida infections.2