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Cutaneous alternariosis in a cardiac transplant recipient
T K Gilmour1, E Rytina, P B O'Connell
1Departments of Dermatology, Addenbrooke's Hospital, Cambridge, United Kingdom. tkgilmour@ozemail.com.au
Abstract:
A 55-year-old male cardiac transplant recipient presented with cutaneous nodules on the limbs caused by Alternaria alternata. Oral fluconazole 200 mg daily for 3 weeks was ineffective. Itraconazole 100 mg oral daily was ceased when hyperglycaemia developed. Individual lesions were successfully treated with either curettage and cautery or double freeze-thaw cryotherapy. Alternaria spp. are ubiquitous fungal saprophytes which may cause cutaneous infections particularly in immunocompromised patients.
Insights
Cutaneous Alternaria alternata infection in a cardiac transplant patient was resistant to oral antifungals. Localized treatments like cryotherapy and curettage effectively resolved skin lesions in this immunocompromised individual.
Area of Science:
- Mycology
- Dermatology
- Transplant Medicine
Background:
- Fungal infections pose a significant risk to immunocompromised patients, particularly organ transplant recipients.
- Alternaria species are common environmental fungi that can cause opportunistic infections.
Observation:
- A 55-year-old male cardiac transplant recipient developed disseminated cutaneous nodules.
- The lesions were confirmed to be caused by Alternaria alternata.
Findings:
- Standard oral antifungal therapy with fluconazole was ineffective.
- Itraconazole was discontinued due to induced hyperglycemia.
- Successful treatment was achieved through localized interventions: curettage and cautery, or double freeze-thaw cryotherapy for individual lesions.
Implications:
- Cutaneous Alternaria infections can be challenging to treat in immunocompromised hosts.
- Localized therapies may be effective when systemic antifungals fail or are contraindicated.
- This case highlights the importance of considering topical or procedural treatments for localized fungal skin infections in transplant patients.