Cutaneous alternariosis treated with miconazole

A 40-year-old man had had a chronic, slowly spreading inflammatory process in the skin over the right knee of ten years' duration. Culture of a biopsy specimen grew Alternaria sp. Antimycotic susceptibility testing with flucytosine, amphotericin B, and miconazole nitrate was performed. The Alternaria was highly sensitive to the last two drugs. Miconazole nitrate, 1.2 g daily intravenously for 31 days, did not induce a clinical response. The lesions were then infiltrated with 10 mg of miconazole nitrate in 10 mL of polyethoxylated castor oil (Cremophor EL) twice weekly, with clearing of the lesions during a several-month period.