[Alternaria tenuissima plurifocal cutaneous infection]

Multiple skin localization of phaeohyphomycoses are rare and are encountered in immunodepressed subjects. We report a case due to Alternaria tenuissima in a patient given corticosteroids and IgA deficiency.

A 73-year-old man presented with ulceronecrotic lesions on the two lower limbs which had developed over 15 days and poor general health. He had been taking corticosteroids for retroperitoneal fibrosis for 15 days. Skin biopsies demonstrated monoclonal dysglobulinaemia with IgG kappa and IgA deficiency. Itraconazol treatment was successful.

Identification of Alternaria is in a skin sample, it not sufficient to determine its pathogenic nature. Strict criteria, especially histological criteria, are required. Most cases of cutaneous alternariosis are localized infections due to direct inoculation. They are seen in healthy patients or more often in immunodepressed subjects. Disseminated skin disease is rare and has been reported in 2 highly immunodepressed patients. Our patient was taking corticosteroids, but his deficiency state in IgA may have played a role in the development of the mycosis. Itraconazol appears to be effective treatment.