Two new cases of cutaneous alternariosis with a review of the literature

Abstract

Two cases of cutaneous phaeohyphomycosis due to Alternaria tenuissima in patients affected with primitive myeloproliferative syndrome and lymphocytic lymphoma respectively are reported. Following a review of the specific literature, the authors discuss the etiopathogenic mechanisms, the clinical and histologic aspects of the lesions and the therapeutic problems.

Sporotrichoid phaeohyphomycosis due to Alternaria infectoria.

“…1 In the literature A. alternata has commonly been considered as the causative organism of cutaneous alternariosis. 2,5,7,8 Successful treatment of cutaneous alternariosis with itraconazole has been reported previously. 5,8 Attention must be paid to possible interactions with other concurrent medications.…”

“…Verruciform and eczematous skin lesions, chronically vegetating tumorous infiltrates and multiple ulcerating lesions have been documented in the literature. 2,7 The histological picture of cutaneous alternariosis is characterized by a granulomatous infiltrate with histiocytic giant cells, and the presence of spheroidal chlamydospore-like structures and gnarled, thickwalled, septate elements. 2,6 In some cases pigmented hyphal elements may become detectable with melanin staining (Fontana±Masson), thus leading towards the diagnosis of phaeohyphomycosis.…”

Cutaneous alternariosis in transplant recipients: Clinicopathologic review of 9 cases

“…Epidermal alternariosis is manifested as scaly infiltrated erythema or ulcers, where fungal hyphae are found in the most superficial layers of the skin. 17 However, because Alternaria has been isolated in 15% of samples from assumed fungal lesions, 17 the significance of this superficial or epidermal form remains controversial.…”

“…The majority of the reported patients with cutaneous alternariosis were solid-organ transplant recipients, but patients with Cushing's syndrome, autoimmune bullous diseases, lymphoproliferative disorders, or AIDS have also been described. [13][14][15][16][17] Approximately half of the reported patients with cutaneous alternariosis were receiving systemic corticoesteroids. Some authors have postulated that cutaneous fragility induced by corticosteroids may increase the risk of percutaneous inoculation from the environment.…”

Fungal infections of the immunocompromised host: clinical and laboratory aspects

“…Paecilomyces lilacinum has been associated with cellulitis in an immunosuppressed patient (59). Cutaneous infections have also been reported to be caused by Exophiala jeanselmei (cutaneous nodules) (146), Malassezia furfur (folliculitis) (141), Alternaria species (cutaneous nodular lesions) (132), and Penicillium species (generalized subcutaneous abscesses) (112). Other infections reported include Aureobasidium pullulans (splenic and disseminated infection) (62,104), Rhodotorula species (disseminated infection) (102), Chaetomium species (empyema) (56), Torulopsis candida (fungemia) (115), Curvularia species (nasopharnygeal infection) (80), Cunninghamella species (pneumonia) (130), Geotrichum candidum (disseminated infection) (64), and members of the dematiaceous fungi including Drechslera, Bipolaris, and Exserohilum (1,26,38,86,98).…”