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[Cutaneous Alternaria infection occurring in the course of a treated pemphigus]
M C Machet1, E Stephanov, E Estève
1Service d'Anatomie pathologique, CHU Trousseau, Tours.
Abstract:
Alternaria is a very common fungus. Its pathogenic role in human pathology is mainly expressed by asthma. Cutaneous infection is rare and only about 70 cases have been described. Because of its wide distribution in the environment, cutaneous biopsy is necessary to ensure the diagnosis. We report two cases of dermal alternariosis occurring in the course of pemphigus treated with immunosuppressive therapy. Histological examination revealed a hyperplasic epidermis. The upper dermis showed a mixed inflammatory infiltrate with neutrophils, histiocytes and giant cells. Round intracytoplasmic inclusions staining faintly with PAS wer seen in giant cells. Long intercellular filaments were present in the infiltrate. This histopathological aspect is not specific, and cultures of both cutaneous biopsies were necessary. The association of dermal alternariosis and pemphigus is explained both by the immunosuppressive therapy for pemphigus and by the cutaneous fragility induced by the acantholytic disease permitting direct inoculation of Alternaria.
Insights
Dermal alternariosis, a rare fungal skin infection, occurred in two patients with pemphigus undergoing immunosuppressive therapy. This highlights the risk of opportunistic fungal infections in immunocompromised individuals with skin fragility.
Area of Science:
- Mycology
- Dermatology
- Infectious Diseases
Background:
- Alternaria species are common environmental fungi, primarily known for causing allergic respiratory diseases like asthma.
- Cutaneous alternariosis is a rare clinical manifestation, with fewer than 70 cases previously reported in medical literature.
- Pemphigus is a group of autoimmune blistering diseases characterized by acantholysis, leading to skin fragility.
Observation:
- Two cases of dermal alternariosis are presented in patients with pemphigus receiving immunosuppressive treatment.
- Histopathological examination revealed epidermal hyperplasia, a mixed inflammatory infiltrate in the dermis, and characteristic intracytoplasmic inclusions within giant cells.
- The observed histopathological features were non-specific, necessitating fungal culture for definitive diagnosis.
Findings:
- The study identified a rare association between dermal alternariosis and pemphigus.
- Immunosuppressive therapy for pemphigus and the inherent cutaneous fragility of the disease were identified as key factors facilitating Alternaria inoculation.
- Fungal cultures of cutaneous biopsies confirmed the diagnosis of dermal alternariosis.
Implications:
- This case report underscores the importance of considering opportunistic fungal infections, such as dermal alternariosis, in immunocompromised patients, particularly those with autoimmune skin conditions.
- Clinicians should be vigilant for rare infections in patients with pemphigus on immunosuppressants, considering skin biopsy and fungal cultures for diagnosis.
- Understanding the interplay between immunosuppression, skin barrier defects, and fungal infections can guide preventative strategies and treatment approaches.