The Alternaria species are dematiaceous fungi. Human infection due to dematiaceous fungi is uncommon. Most reported cases of alternariosis have occurred in patients with immunodeficiency. The majority of cases were solid-organ transplantation recipients. Cutaneous alternariosis lesions are usually asymptomatic solitary nodules, plaques of ulcers or subcutaneous cysts. Here we report a case of a 77-year-old female who presented with hemorrhagic skin necrosis in right arm that had developed from hemorrhagic bullae. Her prior medical history included iatrogenic Cushing's syndrome, hypertension, interstitial lung disease and congestive heart failure. Following administration of itraconazole, her lesions improved.
Aged ; Alternaria ; Alternariosis ; Arm ; Cushing Syndrome ; Female ; Fungi ; Heart Failure ; Humans ; Hypertension ; Itraconazole ; Lung Diseases, Interstitial ; Necrosis ; Phaeohyphomycosis ; Skin ; Ulcer

No abstract available.
Alternariosis* ; Transplant Recipients*

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.
Abscess ; Agar ; Aged ; Alternaria* ; Alternariosis ; Alveolitis, Extrinsic Allergic ; Asthma ; Base Sequence ; Biopsy ; Coloring Agents ; Dementia ; Dermis ; Forearm ; Fungi ; Glucose ; Hand ; Humans ; Hyperpigmentation ; Hyphae ; Immunocompromised Host ; Immunosuppressive Agents ; Inflammation ; Ketoconazole ; Methenamine ; Neutrophils ; Olea ; Paraffin ; Parkinson Disease ; Rhinitis ; Skin ; Soil ; Solanum tuberosum ; Spores ; Spores, Fungal ; Weights and Measures

Genus Alternaria is a species of dematiaceous fungi that is commonly found in the atmosphere or in the soil. It can cause hypersensitivity pneumonitis, bronchial asthma, or allergic rhinitis in immunocompromised host such as patient with organ transplantation or long-term steroid using patient. It can rarely cause skin infection. Case 1 was a 74-year-old man with well demarcated and elevated erythematous plaque with irregular scattered pustules on his right forearm. Case 2 was a 77-year-old woman with well demarcated elevated erythematous nodules within erythematous patch on her right forearm. In both cases, the lesions started at the senile purpura site. Herein, we report 2 rare cases of Alternaria alternata on senile purpura site to share the experience.
Aged ; Alternaria ; Alternariosis ; Alveolitis, Extrinsic Allergic ; Asthma ; Atmosphere ; Female ; Forearm ; Fungi ; Humans ; Immunocompromised Host ; Organ Transplantation ; Purpura ; Rhinitis ; Rhinitis, Allergic, Perennial ; Skin ; Soil ; Transplants

The genus Alternaria contains several species of melanized hypomycetes that cause opportunistic human infections. The most frequent clinical manifestations of alternariosis are cutaneous and subcutaneous infections, followed by oculomycosis, invasive and non-invasive rhinosinusitis, and onychomycosis. So far, only 17 cases of rhinosinusitis caused by Alternaria species have been reported since 1977. Although several domestic cases of cutaneous alternariosis have been reported, there is no report of Alternaria rhinosinusitis in Korea. The majority of Alternaria rhinosinusitis involves immunocompromised patients. We report the first case of alternariosis in a patient with neutropenia and myelodysplastic syndrome that was treated with endoscopic debridement and a conventional antifungal agent.
Alternaria ; Alternariosis ; Debridement ; Eye Infections, Fungal ; Humans ; Immunocompromised Host ; Korea ; Myelodysplastic Syndromes ; Neutropenia ; Onychomycosis ; Sinusitis

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.
Administration, Oral ; Alternaria ; Alternariosis ; Dermis ; Female ; Fluconazole ; Forearm ; Fungi ; Giant Cells ; Humans ; Hypertension ; Middle Aged ; Soil ; Spores, Fungal

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.
Alternaria* ; Alternariosis* ; Female ; Fungi ; Humans ; Immunocompromised Host ; Immunosuppression ; Itraconazole ; Middle Aged ; Roxithromycin ; Wrist

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.
Agar ; Alternaria ; Alternariosis* ; Amylases ; Biopsy ; Chloramphenicol ; Female ; Follow-Up Studies ; Humans ; Hyphae ; Immunosuppression ; Inflammation ; Knee ; Liver Transplantation ; Liver* ; Methenamine ; Middle Aged ; Recurrence ; Spores, Fungal

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.
Aged ; Alternaria ; Alternariosis* ; Arthritis, Rheumatoid ; Female ; Forearm ; Fungi ; Humans ; Hyphae ; Immunocompromised Host ; Inflammation ; Itraconazole ; Opportunistic Infections ; Skin ; Spores

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.
Alternariosis* ; Fungi ; Humans ; Immunocompromised Host ; Immunosuppressive Agents ; Kidney Transplantation ; Middle Aged ; Soil ; Transplantation*