Related Experiment Videos
Cutaneous alternariosis: role of corticosteroid-induced cutaneous fragility
1Service de dermatologie, CHU Trousseau, Tours, France.
Abstract:
Alternaria is a very common and saprophytic fungus. Cutaneous infection is rare and about 71 cases have been described, mainly in Europe in immunocompromised hosts. We report a case of dermal alternariosis occurring in a woman treated with corticosteroids for dermatomyositis. The cutaneous lesion consisted of an erythematous and scaly plaque on the leg measuring 2 x 2 cm. Cutaneous biopsy showed hyphae and round inclusions stained with PAS and Gomori-Grocott within a polymorphous granuloma. Cultures of cutaneous biopsies grew Alternaria sp. HIV1 and HIV2 serology was negative. The patient was treated by local excision and corticosteroids were decreased. One-year follow-up showed no recurrence. Cutaneous alternariosis is an opportunistic infection. the disease has been described mainly in patients treated with systemic corticosteroids (39 cases out of the 71 reported cases) or local corticosteroids (3/71) and in patients suffering from Cushing's syndrome (7/71) but rarely in HIV-infected patients (3/71). Cutaneous fragility induced by hypercorticism is an important cofactor permitting direct inoculation from the environment.
Insights
Cutaneous alternariosis, a rare fungal infection, typically affects immunocompromised individuals. This case highlights a corticosteroid-treated patient who recovered after local excision, emphasizing hypercorticism
Area of Science:
- Mycology
- Dermatology
- Infectious Diseases
Background:
- Alternaria species are common saprophytic fungi with rare potential for human cutaneous infections.
- Cutaneous alternariosis is an opportunistic infection predominantly observed in immunocompromised hosts, particularly those with conditions leading to hypercorticism.
Observation:
- A case of dermal alternariosis is presented in a woman undergoing corticosteroid therapy for dermatomyositis.
- The patient presented with a 2x2 cm erythematous, scaly plaque on the leg.
- Histopathological examination revealed fungal hyphae and inclusions within a granulomatous infiltrate.
Findings:
- Fungal cultures from skin biopsies confirmed the presence of Alternaria species.
- The patient, negative for HIV, was successfully treated with local excision and reduced corticosteroid dosage.
- No recurrence was observed during a one-year follow-up period.
Implications:
- Systemic and local corticosteroid use, as well as Cushing's syndrome, are significant risk factors for cutaneous alternariosis.
- Hypercorticism-induced skin fragility may facilitate fungal inoculation from the environment.
- This case underscores the importance of considering opportunistic fungal infections in patients with prolonged corticosteroid exposure.