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Primary subcutaneous Alternaria alternata infection of the hand in an immunocompromised host
Dzifa S Kpodzo1, Michael S Calderwood, David E Ruchelsman
1Harvard Combined Plastic Surgery Residency Training Program, Department of Plastic and Reconstructive Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA. dkpodzo@partners.org
Abstract:
We describe a case of a progressive subcutaneous Alternaria alternata infection in the hand of a patient with chronic lymphocytic leukemia (CLL). The diagnosis was based upon the examination of tissue biopsy and isolation of the etiologic agent in culture. The identity of the isolate was determined by phenotypic characteristics and by sequencing the ITS and D1/D2 regions of the rDNA. Despite combination therapy with voriconazole and micafungin, the lesion continued to progress. Posaconazole therapy, along with surgical excision of the infected tissue, resulted in the eradication of infection. The limitations of the clinical management of invasive Alternaria infections are discussed.
Insights
A progressive subcutaneous infection caused by Alternaria alternata in a patient with chronic lymphocytic leukemia (CLL) was successfully treated. Posaconazole combined with surgical excision eradicated the infection after other therapies failed.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Subcutaneous fungal infections can be challenging to manage, particularly in immunocompromised individuals.
- Chronic lymphocytic leukemia (CLL) increases susceptibility to opportunistic infections.
- Alternaria alternata is an emerging cause of fungal infections in humans.
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