Cutaneous infection caused by Alternaria in patients receiving tacrolimus.
Tacrolimus, an immunosuppressant used in organ transplant surgery, is inhibitory to some medically important fungi but also may obstruct azole monotherapy in the immunocompromised patient. We observed a case of cutaneous phaeohyphomycosis caused by Alternaria alternata in a liver transplant recipient who had been under tacrolimus immunosuppression for 6 months post-transplantation. At the onset of the infection, the patient presented with an increased whole-blood tacrolimus level. After a simple surgical excision the patient was discharged from the hospital without antifungal treatment but with an adjusted tacrolimus dosage. Literature review on fungal infections in patients receiving tacrolimus suggested these patients experience cutaneous and deep mould infections that are more frequent, severe and therapy-refractory than those seen in patients with other types of immunosuppression.
Department of Dermatology, Complejo Hospitalario Universitario, Faculty of Medicine, Santiago de Compostela, Spain. manuelpe@usc.es
M
M
Pereiro
Maria M
MM
Pereiro Ferreirós
G S
GS
De Hoog
J
J
Toribio
D000368:Aged; D000528:Alternaria / Q000145:classification / Q000166:cytology / Q000302:isolation & purification* / Q000502:physiology; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000302:isolation & purification; D003881:Dermatomycoses / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D017422:Sequence Analysis, DNA; D016559:Tacrolimus / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*
D021903:DNA, Ribosomal Spacer; D007166:Immunosuppressive Agents; D016559:Tacrolimus