Cutaneous Alternariosis – a Diagnostic and Therapeutic Problem

Overview

A 53-year-old woman developed two livid-pinkish smooth nodules on her right extremity two months after renal transplantation. Clinical picture was suggestive for the diagnosis of malignant lymphoma but histopathology examination revealed a cutaneous mycosis and tissue cultivation yielded an Alternaria sp. The nodule on the forearm was totally excised while the nodule on the dorsum of the hand had to be left in place considering its localization, size and the immune suppression due to prednisone, azathioprine and tacrolimus. Systemic antifungal monotherapy with itraconazole and terbinafine, successively, failed. On the contrary, new cutaneous lesions appeared. Combined therapy with itraconazole 400 mg a day and terbinafine 250 mg a day continued for 4 months led to complete resolution.

Key words:
cutaneous alternariosis – differential diagnosis – therapy