Cutaneous alternariosis in transplant recipients: Clinicopathologic review of 9 cases

Gilaberte, Montserrat; Bartralot, R.; Torres, Jennifer; Reus, Ferran Sánchez; Rodríguez, Virginia Carbajosa; Alomar, A.; Pujol, Ramón M.

doi:10.1016/j.jaad.2004.10.875

Cited by 87 publications

(59 citation statements)

References 24 publications

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“…[3][4][5]9 Itraconazole doses used range between 100 and 400 mg for 2-8 months in monotherapy regimens. 3,6,7 This case report is remarkable due to its clinical presentation with multiple nodules and vegetating tumours as well as the slow but successful response to monotherapy with high-dose itraconazole. Furthermore, it illustrated the efficacy of molecular techniques in Alternaria species identification.…”

Section: Discussionmentioning

confidence: 90%

“…Fungal elements are usually seen within these infiltrates, presenting as spheroidal chlamydospore-like structures and hyphae, with and without pigmentation. 6,7 Fungal culture on Sabouraud agar without cycloheximide yields "greyish", "green, powdery" or "felty" colonies. By lactophenol cotton blue staining, the microscopic observation of pigmented conidiophores giving rise to dictyospores is highly suggestive of A. infectoria.…”

Section: Discussionmentioning

confidence: 99%

“…On occasion, a combination of surgical and systemic antinfungal agents has proved efficacious. 7,16 Itraconazole is the most commonly used drug, followed by amphotericin B. [3][4][5]9 Itraconazole doses used range between 100 and 400 mg for 2-8 months in monotherapy regimens.…”

Section: Discussionmentioning

confidence: 99%

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Phaeohyphomycosis caused by Alternaria infectoria presenting as multiple vegetating lesions in a renal transplant patient

Cunha

Amaro

Vieira

et al. 2012

Revista Iberoamericana de Micología

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a b s t r a c tThe genus Alternaria is one of the most common black moulds and appears to be increasing as a causative agent of subcutaneous phaeohyphomycosis, particularly among immunosuppressed patients.A 53-year-old patient who had received a kidney transplant presented with multiple verrucous lesions on the distal extremities. Positive histopathology and cultures, in addition to rDNA ITS region sequencing, identified the fungal isolate as Alternaria infectoria. Oral itraconazole was administered for 10 months. A follow-up at 15 months demonstrated no signs of infection.Clinical manifestations of cutaneous alternariosis vary significantly and only a few cases have been described in the literature. Although optimal treatment options remain controversial, this case of phaeohyphomycosis was successfully treated with itraconazole monotherapy.© 2010 Revista Iberoamericana de Micología. Published by Elsevier España, S.L. All rights reserved.Feohifomicosis producida por Alternaria infectoria con presentación clínica de múltiples lesiones vegetantes en un paciente sometido a un trasplante renal r e s u m e n Las especies del género Alternaria son mohos ubicuos que se caracterizan por presentar colonias de color gris; parecen ser cada vez más frecuentes como agente causal de las feohifomicosis subcutáneas, en especial entre pacientes inmunocomprometidos. Un paciente de 53 años de edad, que se había sometido a un trasplante renal, consultó por presentar tumores verrugosos en el tercio distal de las extremidades. La histopatología y cultivo positivos, además de la secuenciación de la región de transcripción interna ITS del rDNA, permitieron la identificación del aislamiento fúngico como Alternaria infectoria. Se instauró tratamiento con itraconazol oral durante 10 meses y, a los 15 meses de seguimiento, se demostró la ausencia de signos de infección.Las manifestaciones clínicas de la alternariosis cutánea son muy variables y tan sólo se han descrito unos pocos casos en los que se presenta en forma de tumoraciones verrugosas. Aunque el tratamiento de elección sigue siendo motivo de controversia, el paciente presentado en este estudio fue tratado satisfactoriamente con itraconazol.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Phaeohyphomycosis caused by Alternaria infectoria presenting as multiple vegetating lesions in a renal transplant patient

Cunha

Amaro

Vieira

et al. 2012

Revista Iberoamericana de Micología

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“…Cutaneous and subcutaneous alternosis in immunosuppressed individuals is the most common presentation (8-11). The major risk factors for cutaneous/subcutaneous diseases are organ transplantation and Cushing's syndrome (12). While bone marrow recipients are at risk for sinusitis, Ocular disease is seen in individuals exposed to soil and garbage and nail involvement is rarely reported.…”

Section: Discussionmentioning

confidence: 99%

Invasive Rhinosinusitis due to Alternaria alternata and Rhizopus arrhizus Mixed Infection: A Case Report and Review

et al. 2016

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Introduction: Rhizopuse Sp. are common infectious agents of invasive rhinosinusitis. Though Alternaria is known to cause allergic rhinosinusitis, invasive sinusitis because of Alternaria Sp. is rare. Coinfections with bacteria and fungus causing rhinosinusitis have been reported as have the Rhizopus infection with other fungus such as Aspergillus, Candida, and Exserohillum. However Rhizopus coinfection with Alternaria has not been reported to the best of our knowledge. Case Presentation: A sixty-year-old woman was admitted with periorbital pain, swelling and complete restriction of movement of her right eye. She had diabetes mellitus for fifteen years. Diagnosis of invasive sinusitis was confirmed by hyperintensities in her right maxillary and bilateral ethmoid sinuses on the MRI on her brain and demonstration of hyphal forms from sinus mucosa. Culture confirmed the presence of Alternariaalternata and Rhizopus arrhizus. Patient responded to treatment with Amphotercin B and had complete resolution. Conclusions: Co-infection with bacteria and mixed fungal infection should be looked for as treatment strategies may differ with different organisms. Presumptive treatment should include agents, which can cover the broadest possible range of organism known to cause invasive sinusitis.

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“…Most reports of dermal cutaneous alternariosis are on exposed sites of the extremities. 7,8 As solid-organ transplant becomes increasingly widespread and recipients survive longer, cutaneous fungal infections will be more frequently encountered. 9 Cutaneous alternariosis in a heart transplant recipient is rare.…”

Section: Discussionmentioning

confidence: 99%

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

Sharif-Kashani

Farshidpour²,

Droudinia³

et al. 2013

Exp Clin Transplant

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Cutaneous alternariosis infection occurs mainly in immunocompromised individuals. The incidence of alternariosis in a heart transplant recipient is infrequent. Coincidence of the aforementioned infection with additional fugal agents is rare. We describe a case of alternariosis with Trichosporon fungal infection in a patient who was successfully treated with combined antifungal therapy, modulation of immunosuppressive regimen, and blood glucose management. The patient had a good response to treatment, and has had an uneventful 1-year follow-up at the time of this writing.

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Cutaneous alternariosis in transplant recipients: Clinicopathologic review of 9 cases

Cited by 87 publications

References 24 publications

Phaeohyphomycosis caused by Alternaria infectoria presenting as multiple vegetating lesions in a renal transplant patient

Phaeohyphomycosis caused by Alternaria infectoria presenting as multiple vegetating lesions in a renal transplant patient

Invasive Rhinosinusitis due to Alternaria alternata and Rhizopus arrhizus Mixed Infection: A Case Report and Review

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

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