Cutaneous alternariosis in a renal transplant recipient

Abstract

A 55-year-old man who rejected a renal transplant presented with cutaneous nodules on both lower leg. He underwent transplantation 4 months previously and had since been treated with FK-506, mycophenolate mofetil and prednisone. Physical examination revealed small, brown-colored firm nodules on both lower legs (Fig. 1). The lesions were asymptomatic and there was no history of local trauma.A biopsy of the nodules was performed and showed roundshaped fungus spores and hyphae scattered in a mixed granulomatous inflammation of the dermis ( Fig. 2A). Hyphae and round-shaped fungal cells in the dermis stained positive with periodic acid-Schiff and Gomori-methenamine silver stain. The biopsy specimen was cultured in Sabourauds dextrose agar, supplemented with chloramphenicol and without cycloheximide. A cottony olive-brown colony was isolated within 4 days of incubation at 26 ° C. Microslide culture was made, which grew colonies and was stained with lactophenol cotton blue. Microscopy revealed that the colonies consisted mainly of darkly pigmented conidia, which had both trans-verse and longitudinal septa and conidiophores with 1 -3 septa (Fig. 2B). Based on these morphological findings the fungus was identified as Alternaria spp. There was no sign of systemic dissemination of the disease. The patient was treated Figure 1 Non-symptomatic brown-colored deep-seated nodules on both lower legsFigure 2 (A) Round-shaped fungus spores and hyphae are scattered in a mixed granulomatous inflammation of the dermis (hematoxylin and eosin; original magnification × 400). (B) Transverse and longitudinal septated muriform conidia were seen (lactophenol cotton blue; original magnification × 400); inset: close view of the conidia

Cutaneous Alternariosis With Trichosporon Infection in a Heart Transplant Recipient: A Case Report

“…They are opportunistic fungi that typically infect immunocompromised or debilitated patients. [1][2][3] Most affected individuals are immunosuppressed owing to Cushing's syndrome, kidney transplants, hematologic malignant diseases, and acquired immunodeficiency syndrome. 4 …”