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Cutaneous alternariosis in association with scabies or iatrogenic Cushing's syndrome
1Department of Dermatology, National Cheng-Kung University Medical Center, Tainan, Taiwan R.O.C.
Abstract:
Cutaneous alternariosis is rare. Most infections occur in immunocompromised hosts. We report the first three cases in Taiwan. The patients were elderly farmers residing in Tainan. They developed indolent, erythematous, ulcerated or crusted papules, plaques or pustules over the extensor aspect of the forearms or hands. Pure colonies of Alternaria sp were isolated from biopsy specimens in each case. The diagnosis was confirmed by detecting pleomorphic fungal elements in the dermis within suppurative, granulomatous infiltrates. All three patients were immunocompromised. They showed a negative reaction to an intradermal test of seven common antigens. Cases 2 and 3 had iatrogenic Cushing's syndrome. Cases 1 and 3 had extensive scabies, which in Case 1 was of the Norwegian type. To the best of our knowledge, scabies associated with alternariosis has not been reported previously. The infection showed spontaneous regression in Case 1; in Case 2, it resolved after seven weeks of intralesional amphotericin B at a dose of 1 mg/mL twice a week.
Insights
Cutaneous alternariosis, a rare fungal infection, was observed in three immunocompromised elderly farmers in Taiwan. This study highlights a potential link between alternariosis and scabies, a previously unreported association.
Area of Science:
- Dermatology
- Mycology
- Infectious Diseases
Background:
- Cutaneous alternariosis is an uncommon fungal infection, typically affecting individuals with compromised immune systems.
- This report details the first documented cases of cutaneous alternariosis in Taiwan.
Observation:
- Three elderly farmers in Tainan presented with indolent skin lesions, including erythematous, ulcerated, or crusted papules and plaques on their forearms and hands.
- All patients were immunocompromised, with two exhibiting iatrogenic Cushing's syndrome and two presenting with extensive scabies, including Norwegian scabies in one case.
- Pure cultures of Alternaria species were isolated from biopsy specimens, and fungal elements were identified in the dermis.
Findings:
- The diagnosis of cutaneous alternariosis was confirmed in all three patients.
- A novel association between cutaneous alternariosis and scabies was observed in two patients.
- One patient experienced spontaneous regression of the infection, while another resolved after treatment with intralesional amphotericin B.
Implications:
- This study expands the understanding of clinical presentations and risk factors for cutaneous alternariosis.
- The findings suggest that scabies may be a predisposing factor or a co-infection in cutaneous alternariosis, particularly in immunocompromised individuals.
- The successful treatment of one case with intralesional amphotericin B provides a potential therapeutic option for this rare fungal infection.