Cutaneous Alternaria alternata infection successfully treated with itraconazole

Abstract

A case of cutaneous alternariosis due to Alternaria alternata in a 47-year-old man who had the CREST (calcinosis, Raynaud's phenomenon, oesophageal dysfunction, sclerodactyly and telangiectasia) syndrome with pulmonary hypertension is presented. The patient, who lived in a rural area and was receiving prostacycline by continuous infusion, prednisone and azathioprine for his underlying disease, showed cutaneous lesions of the lower extremities spreading from the knees to the ankles. The patient was successfully treated with high doses of oral itraconazole.

Cutaneous alternariosis in transplant recipients: Clinicopathologic review of 9 cases

“…Conversely, Alternaria species are resistant to griseofulvin and flucytosine. Oral and intralesional miconazole, 25 itraconazole, 23,26,27 fluconazole, terbinafine, 28 and amphotericin B 27 have been used with variable success. Some authors have postulated that itraconazole should be the treatment of choice, but the dose and duration of treatment are not fully established.…”

Melanized Fungi in Human Disease

“…Alternaria spp. are by far the most common etiologic agent, with a recent review cataloguing over 156 cases up to 2007 (195,191,275,373,542,577,710,751). Exophiala spp.…”

Cutaneous alternariosis revealing acute myeloid leukaemia in an adult patient

“…Optimal treatment approaches for cutaneous alternariosis have not been established yet 26 . In immunocompromised patients, either surgical excision or antifungal drug therapy in case of numerous or large lesions, have been proposed 7,8,21,22,26 …”

“…It can be found on normal human skin as colonizer and is rarely involved in human diseases as hypersensitivity pneumonitis, bronchial asthma, paranasal sinusitis with and without osteomyelitis, peritonitis, keratitis and cutaneous and subcutaneous infections 1–3 . Cutaneous alternariosis has been usually reported in immunocompromised hosts with cancer, history of organ transplantation, immunosuppressive therapy, endocrine and autoimmune diseases and haematological malignancies 4–18 . Only 14 cases of cutaneous alternariosis have been described in immunocompetent individuals, particularly in agricultural workers 19 …”

“…[1][2][3] Cutaneous alternariosis has been usually reported in immunocompromised hosts with cancer, history of organ transplantation, immunosuppressive therapy, endocrine and autoimmune diseases and haematological malignancies. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Only 14 cases of cutaneous alternariosis have been described in immunocompetent individuals, particularly in agricultural workers. 19 We present a case of an adult patient, in which the diagnosis of cutaneous alternariosis led to the diagnosis of an underlying acute myeloid leukaemia.…”