Journal Article

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

Kirsten E. Lyke, Nancy S. Miller, Laura Towne and William G. Merz

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 32, issue 8, pages 1178-1187
Published in print April 2001 | ISSN: 1058-4838
Published online April 2001 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/319751
A Case of Cutaneous Ulcerative Alternariosis: Rare Association with Diabetes Mellitus and Unusual Failure of Itraconazole Treatment

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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.

Journal Article.  5739 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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