A Case of Cutaneous Ulcerative Alternariosis: Rare Association with Diabetes Mellitus and Unusual Failure of Itraconazole Treatment

• Published in: Clinical infectious diseases Vol. 32; no. 8; pp. 1178 - 1187
• Main Authors: Lyke, Kirsten E., Miller, Nancy S., Towne, Laura, Merz, William G.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.04.2001; University of Chicago Press
• Subjects: Aged; Aged, 80 and over; Alternaria; Alternaria - isolation & purification; Alternariosis; amphotericin B; Antifungal Agents - therapeutic use; Associated diseases and complications; Biological and medical sciences; Biopsies; Diabetes Complications; Diabetes mellitus; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Fungal infections; Fungi; Histology; Humans; Infections; itraconazole; Itraconazole - therapeutic use; Leg Ulcer - complications; Leg Ulcer - drug therapy; Leg Ulcer - microbiology; Leg Ulcer - pathology; Lesions; Major Articles; Medical sciences; Mycoses - complications; Mycoses - drug therapy; Mycoses - microbiology; Mycoses - pathology; Steroid therapy; Treatment Failure; Endocrinopathy; Skin disease; Mycosis; Diabetes mellitus; Alternaria alternata; Fungi; Infection; Case study; Antifungal agent; Chemotherapy; Treatment; Triazole derivatives; Complication; Skin; Fungi Imperfecti; Failure; Bibliographic review; Thallophyta; Itraconazole
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/319751

Alternaria species are ubiquitous dematiaceous fungi that are increasingly recognized as pathogens in immunocompromised patients or those with significant underlying disease, but they are also pathogens in otherwise healthy hosts. We describe a case of dermal cutaneous ulcerative alternariosis in a frail 83-year-old patient with diet-controlled diabetes mellitus. Histological analysis revealed hyphal morphology in tissue sections that was initially confused with that of a zygomycetous fungus, and multiple positive culture results were necessary to identify the organism. Treatment with oral itraconazole and surgical debridement were ineffective; clinical improvement was achieved by means of treatment with intravenous amphotericin B lipid complex. We review the literature regarding the role of diabetes mellitus in cutaneous alternariosis and regarding the efficacy of treatment with itraconazole, which has been used very successfully. To our knowledge, this is only the second case report noting diabetes mellitus uncomplicated by steroid administration as a possible predisposing factor for cutaneous infection.