Cutaneous alternariosis treated with miconazole

Abstract

A 40-year-old man had had a chronic, slowly spreading inflammatory process in the skin over the right knee of ten years' duration. Culture of a biopsy specimen grew Alternaria sp. Antimycotic susceptibility testing with flucytosine, amphotericin B, and miconazole nitrate was performed. The Alternaria was highly sensitive to the last two drugs. Miconazole nitrate, 1.2 g daily intravenously for 31 days, did not induce a clinical response. The lesions were then infiltrated with 10 mg of miconazole nitrate in 10 mL of polyethoxylated castor oil (Cremophor EL) twice weekly, with clearing of the lesions during a several-month period.

Cutaneous infection with Alternaria alternata complicating immunosuppression: successful treatment with itraconazole

“…Miconazole has been used and in one report required intralesional injection to induce clearance. 12 More recent reports have focused on itraconazole as an effective therapy, 13,14 and this is also demonstrated in our patient. In vitro activity against Alternaria species has been demonstrated.…”

A case of Alternaria alternata (Fr.) Keissler infection of the knee

“…Our case, as well as the one reported by Moragas et al (1981) was successfully treated with intralesional infiltrations of miconazole. Intravenous miconazole was tried by Moragas et al (1981) but although the drug was well tolerated with no untoward side-effects, there was no clinical response. Intralesional infiltration with miconazole would appear to be the drug of choice for the treatment of single skin lesions caused by Alternaria species.…”

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.…”