Cutaneous alternariosis by Alternaria chartarum in a renal transplanted patient

Cutaneous Phaeohyphomycosis Caused byAlternaria alternataUnresponsive to Itraconazole Treatment

“…Triazoles such as voriconazole, posaconazole, and itraconazole are the most active antifungal agents available [1]. Itraconazole is the preferred drug of choice, because of the lower toxicity and easier administration, and because there is greater clinical experience [12], curiously, in our case itraconazole was ineffective. Surgical excision may be effective, but in our case was not feasible due to extension of the lesions.…”

“…Clinically, most presentations are localized skin infections typically occurring on exposed areas of the body, especially the arms and legs, resulting from traumatic inoculation [1, 2, 5, 6, 12]. …”

Sporotrichoid phaeohyphomycosis due to Alternaria infectoria.

“…10 Because successful treatment of cutaneous alternariosis with itraconazole has been reported, 5,8,10 this drug appears to be the first-line treatment in this condition, especially in recognition of its low toxicity.…”

Onychomycosis due to Ulocladium botrytis

“…Moreover, U. botrytis is distinguished from U. chartarum by virtue of its conidiophores which are generally erect and branched (largely unbranched in U. chartarum ), the disposition of its conidia in single elements (prevalently chains in U. chartarum ) and its hyaline conidial scars (brown in U. chartarum ). Because of morphological similarities with the genus, Alternaria , some reported cases of subcutaneous infections caused by U. chartarum were initially erroneously classified as alternariosis 2,4 . They occurred in immunodepressed patients and were successfully treated by exeresis and/or systemic antimycotics (griseofulvin, ketoconazole, itraconazole).…”

“…They are rarely pathogenic for humans. Ulocladium chartarum has been isolated in five cases of cutaneous infection in immunodepressed patients 1–5 . No cases of infection by U. botrytis have hitherto been reported.…”