title: Alternaria alternata soft tissue infection in a forearm transplant recipient.
abstract: BACKGROUND
  Composite tissue allograft recipients require intensive immunosuppression and are therefore at risk of infections. Filamentous fungal infections are among the complications most difficult to manage in organ transplant recipients.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  Two years after bilateral forearm transplantation, a 35-year-old patient presented with a tumor-like lesion on his thigh after a penetrating injury caused by a sliver acquired during hiking. The lesion was excised completely, and microscopic examination revealed a filamentous fungal infection. Alternaria alternata was identified as the causative agent. Induction therapy with liposomal amphotericin B for one week followed by oral itraconazole maintenance therapy for eight weeks was successful, with no signs of recurrence or side effects at 18 months' follow-up.
  
  
  CONCLUSIONS
  This is the first reported case of invasive A. alternata infection in a composite tissue allograft recipient. The infection was managed successfully with local excision and systemic antifungal treatment.
authors.affiliation: Department of General and Transplant Surgery, Medical University, Innsbruck, Austria. hugo.bonatti@dr.com
authors.forename: Hugo
authors.initials: H
authors.lastname: Bonatti
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lass-Flörl
authors.forename: Bettina
authors.initials: B
authors.lastname: Zelger
authors.forename: Clemens
authors.initials: C
authors.lastname: Lottersberger
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneeberger
mesh_terms: D000328:Adult; D000528:Alternaria; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001132:Arm / Q000637:transplantation*; D004359:Drug Therapy, Combination; D005542:Forearm; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D009181:Mycoses / Q000188:drug therapy* / Q000601:surgery; D014180:Transplantation; D014946:Wound Infection / Q000188:drug therapy* / Q000601:surgery; D014950:Wounds, Penetrating / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D017964:Itraconazole; D000666:Amphotericin B