title: Subcutaneous phaeohyphomycosis due to Alternaria infectoria in a renal transplant patient: surgical treatment with no long-term relapse.
abstract: BACKGROUND
  Phaeohyphomycosis can be caused by a number of different species, being the most common Alternaria alternata and Alternaria infectoria. The biggest risk factor for the development of the infection is immunosuppression.
  
  
  OBJECTIVE
  We present the case of a 64-year-old male renal transplant patient who came to hospital for presenting a tumour in the Achilles region which had been gradually growing in size.
  
  
  METHODS
  A skin biopsy was taken for histological study and culture of fungi and mycobacteria. Blood tests and imaging studies were performed.
  
  
  RESULTS
  Histopathology study and cultures identified A. infectoria as the causal agent. Imaging studies ruled out internal foci of infection. The lesion was surgically removed with no signs of recurrence after 24 months of follow-up.
  
  
  CONCLUSIONS
  There are no treatment guidelines at present for cutaneous and subcutaneous Alternaria spp. infections. Various systemic antifungals have been used, either in combination with surgical removal or alone, with varying results. Surgery alone could be useful in the treatment of solitary, localised lesions in transplant patients in whom there are difficulties in controlling immunosuppression.
authors: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain. Electronic address: rsalidovallejo@aedv.es.
authors: Rafael
authors: R
authors: Salido-Vallejo
authors: Department of Microbiology, Faculty of Medicine, Universidad de Córdoba, Córdoba, Spain.
authors: María José
authors: MJ
authors: Linares-Sicilia
authors: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors: Gloria
authors: G
authors: Garnacho-Saucedo
authors: Department of Pathology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors: Marina
authors: M
authors: Sánchez-Frías
authors: Department of Microbiology, Faculty of Medicine, Universidad de Córdoba, Córdoba, Spain; Department of Microbiology, Hospital Universitario Reina Sofía, Faculty of Medicine, Universidad de Córdoba, Córdoba, Spain.
authors: Francisco
authors: F
authors: Solís-Cuesta
authors: Microbiology Unit, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain.
authors: Josepa
authors: J
authors: Gené
authors: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors: José Carlos
authors: JC
authors: Moreno-Giménez
mesh_terms: D000528:Alternaria / Q000302:isolation & purification*; D003881:Dermatomycoses / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D060446:Phaeohyphomycosis / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D012074:Remission Induction