title: Visceral phaeohyphomycosis caused by Alternaria alternata offering a diagnostic as well as a therapeutic challenge.
abstract: Phaeohyphomycosis is a heterogeneous group of opportunistic infections caused by dematiaceous molds, which are distributed worldwide as plant pathogens but rarely cause human diseases. However, due to the growing populations of immunocompromised patients, these fungi are frequently recognized as important human pathogens. We are reporting this very rare, unique case for the first time from Islamabad, Pakistan, describing the association of visceral Phaeohyphomycosis caused by the opportunistic fungus Alternaria alternata, affecting the left kidney, with the immunocompromised state in a young incidentally detected patient with insulin-dependent type I diabetes. The case was diagnosed on the basis of a high index of clinical suspicion, microbial cultures, microscopy, imaging studies and endourological procedures. The patient did not respond well to the highly sensitive Amphotericin B, resulting in loss of the kidney. Therefore, we suggest that clinicians involved in treating immunocompromised patients should have a high degree of clinical suspicion for such opportunistic pathogens to allow timely initiation of the correct diagnostic and therapeutic work-up.
authors.forename: H
authors.initials: H
authors.lastname: Raza
authors.affiliation: Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad, Pakistan.
authors.forename: R U
authors.initials: RU
authors.lastname: Khan
authors.forename: K
authors.initials: K
authors.lastname: Anwar
authors.forename: K
authors.initials: K
authors.lastname: Muhammad
mesh_terms: D000528:Alternaria / Q000187:drug effects* / Q000276:immunology / Q000302:isolation & purification; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D006869:Hydronephrosis / Q000382:microbiology / Q000601:surgery; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016867:Immunocompromised Host; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D009392:Nephrectomy; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D060446:Phaeohyphomycosis / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D000666:Amphotericin B