Diagnosis: Alternariosis
LONDON Culture of a biopsy specimen revealed the presence of the ubiquitous fungus Alternaria alternata, and an indirect immunofluorescence assay found Alternaria antibodies in a titer of 1:640.
Histopathologic examination found a granulomatous infiltrate in the dermis, and a periodic acid-Schiff stain was positive for septated hyphomycetes.
Cutaneous alternariosis can result directly, via traumatic inoculation of the fungus into the skin, or secondarily after inhalation of the conidia and systemic spread to the dermis or epidermis, Dr. Mira Kadurina said at the 14th Congress of the European Academy of Dermatology and Venereology.
Histopathologic findings can include microabscesses or granulomatous formations in the dermis and subcutis.
Hyphal elements in the tissue may be branched, thick-walled filaments; spherical cells; or short chains of oblong cells, explained Dr. Kadurina, who is with the Military Medical Academy in Sofia, Bulgaria.
This patient was not immunocompromised, but most cases of alternariosis have been reported in patients with malignancies, endocrine or autoimmune disease, a history of organ transplantation, or immunosuppressive therapy. More than half of cases have been seen in patients undergoing systemic corticosteroid treatment, Dr. Kadurina said.
The patient received three 14-day courses of itraconazole, 400 mg/day, over a period of 3 months, and responded well clinically. The antibody titer decreased to 1:80. Hyperpigmented scarring remained, but pain and pruritus resolved and no new lesions subsequently appeared.
Granulomatous infiltrate was present in the dermis. Courtesy Dr. Mira Kadurina