Clinical analysis of three cases of disseminated cutaneous alternariosis caused by Alternaria / 中华皮肤科杂志

Objective:To analyze clinical manifestations, histopathological and pathogenic fungus characteristics as well as treatment of 3 cases of disseminated cutaneous alternariosis caused by Alternaria. Methods:Clinical data were collected from 3 cases of disseminated cutaneous alternariosis caused by Alternaria, who were diagnosed in Department of Dermatology, Xijing Hospital from 2019 to 2021, and clinical and histopathological features, fungal culture, strain identification and treatment results were retrospectively analyzed. Results:The 3 patients were aged 55, 41 and 46 years respectively, including 1 male and 2 females. Two patients were previously diagnosed with nephrotic syndrome and 1 with systemic lupus erythematosus. All the patients had a history of taking glucocorticoids and tacrolimus for different durations, and experienced chronic infections. Histopathological examination with hematoxylin and eosin (HE) staining showed double-contour thick-walled spores and knot-shaped thick-walled septal hyphae, but no melanin in skin lesions. Sequencing of the fungal internal transcribed spacer region confirmed that 2 cases were infected with Alternaria alternate, and 1 with Alternaria infectoria. Fungal culture at different temperatures showed that the growth ability of Alternaria markedly decreased at the temperature over 35 ℃. To treat these patients, the dose of tacrolimus was reduced to less than 1/3 of the standard dose, or tacrolimus was switched to other immunosuppressants, and systemic antifungal therapy was also given at the same time. After 7-month treatment, good clinical outcomes were achieved in the 3 patients. Conclusion:Disseminated cutaneous alternariosis is characterized by bilateral hematogenous dissemination and lymphatic distribution in unilateral limbs, and the skin lesions are characterized by verrucous plaques covered with scabs, nodules and/or sinuses.

A Case of Cutaneous Infection by Alternaria alternata / 대한의진균학회지

Alternaria(A.) species are common saprophyte found in the environment such as soil, air, and plants. They are not usually pathogenic in humans but recently, infections by these fungi have occasionally been reported, occurring mostly in immunocompromised patients. They can cause hypersensitivity pneumonitis, bronchial asthma, or allergic rhinitis and rarely skin infection. A 76-year-old man presented with multiple erythematous papules, plaque and pustules with purpuric patches on both forearms and dorsal hands for 6 months. He had been treated for Parkinson's disease and dementia for 3 years but had not been taking any immunosuppressants. Direct smear with KOH was negative. Histopatholoigically, neutrophilic abscess, suppurative granulomatous inflammation and round spores were observed in the dermis. Periodic acid-Schiff and Methenamine silver stains revealed round to oval shaped spores. The biopsy specimen was cultured in potato dextrose agar and a cottony olive green to gray colored colony with black to brown reverse grew at 7 days of culture. The slide culture stained with lactophenol-cotton blue showed brown septated hyphae and obclavate conidia with brown muriform septation. The nucleotide sequences of the ribosomal internal transcribed spacer region of cultured colonies and paraffin blocks of biopsy specimen were identical to that of A. alternata. He was treated with topical ketoconazole cream application for 4 months, and healed leaving hyperpigmentation with scales.

A Case of Cutaneous Alternariosis Treated with Fluconazole / 대한의진균학회지

Alternaria is a common saprophytic fungus found in the environment such as soil, air, and a variety of objects. The cutaneous infection caused by this fungus occurs more frequent in patients with immunocompromission than in immunocompetent people. We report a case of cutaneous alternariosis in a 63-year-old woman presented with a tender erythematous patch on the right forearm. She was on medication only for hypertension. Histopathologic examination showed a dermal mixed-cell infiltrate including multinucleated giant cells. PAS staining revealed fungal elements in the dermis. Microscopic examination of the colonies showed muriform conidia. A diagnosis of cutaneous infection due to Alternaria species was made on the basis of the above mentioned findings. Oral administration of fluconazole revealed resolution of her cutaneous lesion.

A Case of Cutaneous alternariosis due to Alternaria alternata / 대한의진균학회지

Alternaria is a common saprophyte that is not usually pathogenic in humans. However, infections by the fungus have occasionally been documented, occurring mostly in immunocompromised patients. We report a case of cutaneous alternariosis caused by Alternaria alternata in a 64-year-old woman presenting with a coin-sized, slightly elevated, dark red plaque on the right wrist without systemic immunosuppression. Macroscopic and microscopic morphology of fungal culture and histopathological differentiation offered diagnostic possibility. Systemic roxithromycin and itraconazole were administered with a dramatic resolution of the lesion.

A Case of Cutaneous Alternariosis in Liver Transplant Patient / 대한의진균학회지

A case of cutaneous alternariosis is reported in a 61-year-old female who underwent liver transplantation one year earlier. The infection manifested as a crusted papule about 1 cm in diameter on the right knee. Histological examination with silver methenamine and periodic acid-Schiff diastase revealed fungal spores and hyphae with chronic granulomatous inflammation. Biopsy fragments inoculated on Sabouraud-glucose agar with chloramphenicol produced colonies which were identified as Alternaria species on the basis of macroscopic and microscopic characters. Complete excision and treatment with 250 mg/day oral terbinafine for one month resulted in a satisfactory course with no signs of local recurrence over follow-up period of one year.

A Case of Cutaneous Alternariosis / 대한피부과학회지

Alternaria species belong to the group of dematiacious fungi that have increasingly been reported as pathogens in immunocompromised patients, although cutaneous infection is regarded as a rare opportunistic infection. We describe a case of cutaneous alternariosis in a 66 year-old woman with rheumatoid arthritis. The lesions showed asymptomatic, edematous, violaceous scaly patches on both forearms. Histopathologic findings revealed chronic granulomatous inflammation, and PAS staining identified hyphae and spores. The organism was finally isolated as alternaria species by repeated fungal cultures of the tissue. Treatment with 200mg/day oral itraconazole for three months resulted in a marked regression of the skin lesions.

A Case of Cutaneous Alternariosis / 대한의진균학회지

Alternaria species are common plant pathogens and saprophytic fungi. Cutaneous alternariosis is rare and an opportunistic infection in both healthy and immunosuppressed hosts. We report a case of cutaneous alternariosis developed in a 60-year-old female with iatrogenic Cushing syndrome. She had several various sized confluent suppurative ulcers on erythematous plaques on the both forearm clinically. Histology showed mixed-cell granulomatous infiltration with epithelioid cells, lymphocytes, neutrophils and a few plasma cells in the dermis. Many branching septate hyphae and spores were noted within the granulomatous tissue stained with PAS. A fungal culture from biopsy specimen revealed Alternaria species; pigmented hyphae and cornidia which had both transverse and longitudinal septae. The cutaneous lesions treated with terbinafine, 250 mg daily, for 3 months and 1 year later there is no evidence of recurrence.

A Case of Cutaneous Alternariosis / 대한의진균학회지

Alternaria species are common plant pathogens and saprophytic fungi. Cutaneous alternariosis is rare and an opportunistic infection in both healthy and immunosuppressed hosts. We report a case of cutaneous alternariosis developed in a 60-year-old female with iatrogenic Cushing syndrome. She had several various sized confluent suppurative ulcers on erythematous plaques on the both forearm clinically. Histology showed mixed-cell granulomatous infiltration with epithelioid cells, lymphocytes, neutrophils and a few plasma cells in the dermis. Many branching septate hyphae and spores were noted within the granulomatous tissue stained with PAS. A fungal culture from biopsy specimen revealed Alternaria species; pigmented hyphae and cornidia which had both transverse and longitudinal septae. The cutaneous lesions treated with terbinafine, 250 mg daily, for 3 months and 1 year later there is no evidence of recurrence.

A Case of Primary Cutaneous Alternariosis in a Renal Transplant Recipient / 대한이식학회지

Alternariosis is a genus of dematiaceous fungi frequently found in air, soil and plants, but not usually pathogenic in humans. Most reports of alternariosis are immunosuppressed hosts, including solid-organ transplant recipients. We report a case of cutaneous alternariosis in a 53-year-old renal transplant recipient, which was successfully treated with local excision without concomittant reduction of immunosuppressive agents and antifungal therapy.