Cutaneous alternariosis is an opportunistic infection that has been described mainly in patients treated with corticosteroids. We report a case of dermal alternariosis occurring in a woman treated with corticosteroids after a neurosurgery that was unresponsive to itraconazole. Treatment with intravenous voriconazole was initiated, followed by oral protocol, with marked improvement of the lesions.
Dematiaceous or darkly pigmented fungi are responsible for a wide variety of infectious diseases. They are often found in soil and generally distributed worldwide [
A 76-year-old woman, resident in a rural area, came to our observation with multiple slowly growing, painless, erythematous infiltrating plaques, with a verrucoid appearance, occupying the back of hands, forearms, and the distal 2/3 of the arms (Figures
Infiltrating plaques, with a verrucoid appearance, occupying the back of hands (a) and forearms (b).
Histopathological examination revealed an intense inflammatory process in the dermis, and several septate hyphae and round or oval spore-like structures that stained positively with periodic acid Schiff stain (Figures
Segmented hyphae and spherical spore-like bodies in the dermis (PAS: (a) 10×; (b) 40×).
Lesions after 3 weeks of treatment with Voriconazole.
Rare molds are increasingly emerging as a cause of deep and invasive fungal infections. Cutaneous alternariosis can no longer be considered rare. Their importance as opportunistic pathogens is increasing, especially in transplant recipients [
Dematiaceous fungi may have unique pathogenic mechanisms owing to the presence of melanin in their cell walls. It is thought to be a virulence factor by conferring a protective advantage, scavenging free radicals and hypochlorite that are produced by phagocytic cells and normally kill most organisms [
Clinically, most presentations are localized skin infections typically occurring on exposed areas of the body, especially the arms and legs, resulting from traumatic inoculation [
Due to their frequent occurrence as laboratory contaminants,
Therapy is not standardized given the lack of comparative clinical trials, because these are rare infections. Many antifungals have been used with variable success. Triazoles such as voriconazole, posaconazole, and itraconazole are the most active antifungal agents available [
The authors declared that there is no conflict of interest.