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Case Reports
. 2020 Dec 31;5(4):251-255.
doi: 10.3138/jammi-2020-0019. eCollection 2020 Dec.

A case of multifocal cutaneous alternariosis in a patient with hairy cell leukemia

Glenda R Wright  1 , Allison Osmond  2 , Joseph M Blondeau  3 , Shaqil Peermohamed  4
Affiliations
Case Reports

A case of multifocal cutaneous alternariosis in a patient with hairy cell leukemia

Glenda R Wright et al. J Assoc Med Microbiol Infect Dis Can. .

Abstract
in English, French

We present a case of multifocal cutaneous alternariosis in a 69-year-old man with hairy cell leukemia. The patient presented with painful, violaceous nodules of the lower extremities and left forearm. His physical examination was otherwise normal. Biopsy specimens were submitted first for histopathological examination, followed by microbiological testing. Histopathology showed epidermal hyperplasia, intraepidermal abscess formation, and intracellular and extracellular fungal elements. Subsequent microbiological investigations, including fungal culture and polymerase chain reaction (PCR), isolated Alternaria alternata. The patient was treated for cutaneous alternariosis with itraconazole for 12 weeks and demonstrated significant improvement of the lesions. This case highlights the role of dual histopathological and microbiological laboratory investigation in suspected opportunistic cutaneous mycoses.

Les chercheurs présentent un cas d’alternariose cutanée multifocale chez un homme de 69 ans atteint d’une leucémie à tricholeucocytes. Le patient a consulté à cause de nodules violacés et douloureux sur les extrémités inférieures et l’avant-bras gauche. Son examen physique était autrement normal. Des biopsies ont été d’abord soumises en vue d’un examen histopathologique, puis de tests microbiologiques. L’histopathologie a révélé une hyperplasie épidermique, la formation d’abcès épidermiques et des éléments fongiques intracellulaires et extracellulaires. Les explorations microbiologiques subséquentes, y compris les cultures fongiques et l’amplification en chaîne par polymérase, ont isolé l’Alternaria alternata. Le patient a reçu un traitement de 12 semaines à l’itraconazole pour vaincre une alternariose cutanée, et ses lésions ont considérablement diminué. Ce cas souligne l’intérêt de conjuguer l’exploration histopathologique à l’exploration microbiologique dans les cas présumés de mycose opportuniste.

Keywords: antifungal therapy; fungal infections; hôte immunodéprimé; immunocompromised host; infections de la peau et des tissus mous; infections fongiques; infections fongiques invasives; invasive fungal infections; skin and soft tissue infections; traitement antifongique.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Figure 1:
Figure 1:
(a) Violaceous plaques and nodules involving bilateral lower extremities of 69-year-old male patient with hairy cell leukemia, and (b) similar lesions involving left forearm
Figure 2:
Figure 2:
(a) Low power view of skin biopsy from back, demonstrating pseudoepitheliomatous hyperplasia, intraepidermal abscess formation, and dermal inflammation (H&E, 40x magnification); (b) higher magnification of areas of abscess formation with scattered multinucleated giant cells (H&E, 100x magnification); (c) section showing mixed dermal inflammation, granulomas, and intracellular fungal elements (arrow) (H&E, 200x magnification); (d) high power view of intracellular fungal elements (arrow), showing refractile wall and red pigmentation (H&E, 400x magnification); PAS stain highlighting (e) extracellular; and (f) intracellular fungal organisms (PAS stain, 400x magnification) H&E = Hematoxylin and eosin; PAS = Periodic acid–Schiff
Figure 3:
Figure 3:
(a) Fungal culture demonstrating cotton-like surface with green to grey pigmentation (Sabouraoud dextrose agar); (b) and (c) lactophenol blue preparations demonstrating septate hyphae and long chains of brown, rounded conidia with beaked apices and both transverse and oblique septae (lactophenol blue preparation, oil immersion, 500x magnification)
Figure 4:
Figure 4:
(a) Cutaneous lesions on legs at presentation. Lesion after (b) 8 weeks and (c) 12 weeks of systemic itraconazole treatment
See this image and copyright information in PMC

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