Primary subcutaneous Alternaria alternata infection of the hand in an immunocompromised host

Abstract

We describe a case of a progressive subcutaneous Alternaria alternata infection in the hand of a patient with chronic lymphocytic leukemia (CLL). The diagnosis was based upon the examination of tissue biopsy and isolation of the etiologic agent in culture. The identity of the isolate was determined by phenotypic characteristics and by sequencing the ITS and D1/D2 regions of the rDNA. Despite combination therapy with voriconazole and micafungin, the lesion continued to progress. Posaconazole therapy, along with surgical excision of the infected tissue, resulted in the eradication of infection. The limitations of the clinical management of invasive Alternaria infections are discussed.

Keywords:

• Alternaria spp.
• fungal hand infections
• immunocompromised
• surgical management
• antifungal therapy

Acknowledgements

Authors are thankful to Evan Mojica of the Massachusetts General Hospital for isolation and identification of the fungal culture.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This paper was first published online on Early Online on 10 February 2011.