Unusual location of cutaneous alternariosis in an immunocompetent patient

Abstract

Alternaria is a dematiaceous fungus ubiquitously found in nature. It can cause infections, especially in immunocompromised patients. We report a periorbital location of Alternaria infection in an immunocompetent woman with a confusing clinical presentation. The diagnosis was confirmed by a cutaneous biopsy of the cheek. PCR sequencing identified Aternaria alternata species. The evolution was fatal despite antifungal treatment.

First Reported Case of a Clinically Nonresponsive-to-Itraconazole Alternaria alternata Isolated from a Skin Infection of a Nonimmunocompromised Patient from Romania

“…This paper presents the first case report from Romania of a cutaneous alternariosis in a patient without any type of immunosuppression, and only the fourth such case in Europe [ 6 ]. Based on lesions localizations, cutaneous infections with Alternaria alternata usually occur in the extremities.…”

“…The niche of cutaneous infections produced by Alternaria spp. in immunocompetent patients was recently tackled by Jebari et al in a 2022 article which described a case of cutaneous alternariosis and included 10 case reports in order to provide a brief review [ 6 ]. Only six cases were diagnosed at the species level, and five out of six infections were produced by Alternaria alternata .…”

“…Known as a saprophytic and opportunistic mold, its involvement in clinical infections in patients with a compromised immune system is not surprising. However, recent case reports also highlight the presence of Alternaria alternata infections in patients without any type of immunosuppression [ 4 , 5 , 6 ].…”

Cutaneous Alternariosis in Immunosuppressed Patients Treated with Photodynamic Therapy and Oral Antifungals, a Synergistic Strategy

“…This melanized mold can lead to a diverse range of clinical conditions, varying from localized manifestations in specific organs to more widespread systemic infections [ 1 ]. Alternaria infects mainly immunocompromised hosts; although there have been occasional instances of infections in individuals with healthy immune systems [ 2 , 3 ], these cases seldom progress to invasive diseases [ 4 ].…”

“…2 Incubation time starting at 1 hour and progressively increasing to 3 hours, and subsequent illumination with Aktilite ® CL 128 increasing fluence from 37 to 74 J/cm 2 , once a week. 3 Three hours of incubation followed by illumination with Aktilite ® CL 128 (fluence 37 J/cm 2 ), twice weekly. 4 Thirty minutes of incubation and illumination with Aktilite ® CL 128 (fluence 74 J/cm 2 ) once a week, and exposure to daylight half an hour every day until fading of the blue color.…”