Cutaneous infection by Alternaria tenuissima in an immunosuppressed patient

Purpose. We report a case of a cutaneous alternariosis occurring in an immu nosuppressed patient. Patient. A 56-year-old female patient was admitted for papular and nodular lesions on the left leg evolving for one year after a renal transplant. She was on immunosuppressive therapy with cyclosporin and methylprednisolone. Microscopic examination showed a dermal granulomatous reaction with yeast-l ike PAS-positive structure. Cultures of biopsy material yielded colonies of Alternaria tenuissima. There was considerable clinical improvement. though slow, after the administration of itraconazole ( 100 mg/12 hours) and the reduction of the immunosuppressive agents. Comment. Only fungi conidiospores were associated with the tissue reaction, as revealed by light microscopy and ultrastructural study, emphasizing the ir pathogenic role in this infection. Systemic antifungal therapeutical opt ions are discussed. focusing on the possible mechanisms of action of itraco nazole.