RESUMO
Human infections caused by Alternaria alternata are more frequently reported in immunosupressive hosts. In this report, a rarely seen cutaneous infection, caused by A. alternata in an immunocompetent patient was presented. The patient (71-years-old, male) was admitted to the dermatology unit with complaints of an erythematous and squamatous lesion of 5 cm diameter on left malleolar region. The case was evaluated as immunocompetent based on the normal serum total immunoglobulin and complement levels, anti-HIV negativity, and no known underlying disease. A number of Alternaria spp. conidia and hypha were seen in the microscopical examination of KOH treated cutaneous scrapings of the lesion obtained in two different days. Fungal cultures of the skin scrapings yielded the growth of a fungus identified as A. alternata. Although fungal elements were not detected in haematoxylene-eosin stained smears of the skin biopsy, A. alternata was again isolated in the culture of the biopsy specimen. The identification of the fungus was confirmed by a reference center (Mycology Section of Scientific Institute of Public Health, Belgium) and it was integrated to BCCM/IHEM collection under accession number IHEM 22598. Antifungal susceptibility test efforts failed due to a problem in the preparation of fungal suspension. Oral itraconazole (200 mg/day) and bifonazole cream was used for the treatment and the lesion regressed after the 19th day of the therapy. The treatment was continued with oral and local terbinafine for two weeks and the patient fully recovered. Since A. alternata was demonstrated both in the skin scrapings and tissue biopsy through microscopic examination and culture, it was evaluated as the causative agent of skin infection rather than colonization. This was the first A. alternata infection in an immunocompetent patient in the light of the current literature.
