Onychomycosis

Patient is 26-year-old female, who states that for the last two years she has progressively gotten worsening stomach concerns including severe pain after eating. She has not noticed this being associated with any certain foods that she eats including milk or wheat, but spontaneously will have severe troubles leading to ruining her day where she has to stay close to her toilet due to diarrhea and having nausea, and sometimes throwing out. She has seen Clinic for this and was just wanting to rule out food allergy to see if that is contributing to her troubles. She also has been getting skin rashes as circular patchy rashes on the torso for the last four months as well as on her forehead. She has been told that this may be a ringworm type infection and has tried using Lamisil and that also seems to flared the rash. So, she avoids this product. She has also had some significant onychomycosis in the past causing nails to fall off as well and was seeing a podiatrist for this. She did get placed on Diflucan for three months and that did seem to help her nail involvement of this yeast infection. She also has seen a dermatologist for her skin rashes and they have biopsied this and she states that seem that this is most likely indicative of a fungal infection, but is concerned that this could be due to allergy as well and does not know why she has so much trouble with this.

She does have some nasal symptoms including frequent throat clearing and frequent nosebleeds. It does seem to be involved with seasonal changes. She can have some coughing and sinus infections occasionally. She denies any other troubles with seasonal allergies. She does have occasional nosebleeds in June, July, and August usually from dry mucosa. She has had occasional sinus infections, but not too many and has had frequent tension headaches in the past. She also has had frequent tonsillitis twice in the last two years. She does take Benadryl for this and it does provide good relief.

She denies any frequent ear infections, lightheadedness, or hearing impairment. She does get some fleeting dizzy spells occasionally, but has not passed out from this.

She does have some eye itching and redness. She denies tearing, dryness, burning, yellow discharge from eyes, or eyelid irritation. She does have light hurting her eyes during headaches sometimes, and had eyelid swelling in July 2015 with mono. She did have a significant mononucleosis infection last year and that she still feels she is recovering from.

She denies any history of wheezing or lung troubles. She denies any history of allergic skin problems such as eczema or hives and has not been evaluated for allergies in the past.

ASSESSMENT:
1. Concern for food allergy.
2. Abdominal pain, unspecified.
3. Intractable diarrhea.
4. Onychomycosis.
5. Tinea corporis.
6. Headaches.

PLAN:
1. At this time, I discussed with that I do not feel that food allergy is a significant contributor to her stomach concerns. I did recommend her read a book called The Gut Balance Revolution to identify if it could be an imbalance in gut microbes that is causing such a problem with indigestion and her diarrhea as well as possible troubles with her Candida infection. She was significantly concerned for this. She is a young healthy girl and nobody else in the family has these yeast infections, except for her and is not sure why she is having so many troubling symptoms.
2. We dill do blood work to rule out any spread dye allergy including an IgE renata and carmine to be comprehensive although I do not feel that this may be contributing either.
3. I do not feel that her yeast infections and tinea corporis is associated with any type of food allergy, but she may want to try utilizing the FODMAP diet to see if this can help control some of her imbalances in gut microbes.
4. We will followup as needed.

Advertisements

Leave a Reply