title: Cutaneous alternariosis in a renal transplant recipient: a case report and literature review.
abstract: Organ transplant recipients under immunosuppressive therapy have a highly increased risk of acquiring unusual opportunistic infections. Diagnosis of the etiology of infection may be difficult in clinical manifestations, which need further histological and biological investigations. We recently treated a male renal transplant recipient with a cutaneous phaeohyphomycosis due to Alternaria species. The diagnosis was based on microscopy and culture of the skin lesions. Treatment with oral itraconazole for 5 weeks was ineffective, then clinical improvement was achieved by combination of amphotericin B wet-packing and systemic antifungal therapy with oral voriconazole. Alternaria species are ubiquitous plant-inhabiting saprobes, which are increasingly associated with opportunistic phaeohyphomycosis in immunocompromised individuals. To the best of our knowledge, this is the second case report noting sporotrichoid pattern as the manifestation of cutaneous alternariosis. In this context, we reviewed recent renal-transplant-related cutaneous alternariosis reported in the English-language literature during 1995 to 2011 to summarize its clinical features and outcomes, and to guide clinicians in the care of kidney transplant patients with cutaneous alternariosis.
authors.affiliation: Department of Dermatology, National Chung Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Department of Surgery, National Chung Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Shen-Shin
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Department of Surgery, National Chung Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Lee
authors.affiliation: Department of Dermatology, National Chung Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: joly@mail.ncku.edu.tw.
authors.forename: Sheau-Chiou
authors.initials: SC
authors.lastname: Chao
mesh_terms: D000328:Adult; D000368:Aged; D060487:Alternariosis / Q000175:diagnosis* / Q000473:pathology; D001706:Biopsy; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation; D007868:Leg Dermatoses / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000473:pathology; D060446:Phaeohyphomycosis / Q000175:diagnosis* / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology; D012867:Skin / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents
keywords: cutaneous alternariosis; organ transplant recipient; phaeohyphomycosis