A Rare Case of Tracheobronchitis Alternariosis in a Renal Transplant Recipient

cough until 2014. On day 3, chest X-ray was performed, with negative results and did not show any opacity in right and left side chest. Bronchoscopy revealed of the left bronchus thick purulent secretions that on day 5, sent to the Bacteriology Laboratory of the hospital, no bacteria were identified by Gram stain, but in modified Ziehl-Neelsen stain showed macroconidia of Alternaria (Figure 1). In bronchial washings sample, did not bacterial growth on blood agar and MacConkey agar, where it remained negative after 48 hours of incubation on day 7. The final diagnosis was tracheobronchitis alternariosis. The patient started antifungal therapy on day 12 with voriconazole (400 mg daily) and patient was relieved of symptoms within 6 weeks (on day +54). Alternaria has worldwide distribution and is a large and complex genus that encompasses hundreds of species and several species being common saprophytes in soil. AlterInvasive filamentous fungal infections are an important source of morbidity and mortality among the immunocompromised population. Due to long-term immunosuppressive therapy, in organ transplant recipients have a highly increased risk of acquiring unusual opportunistic infections. Alternaria alternata is an uncommon cause of invasive fungal infection and the majority of cases of phaeohyphomycosis due to Alternaria species have been encountered in immunocompromised individuals. In the immunocompromised patient, Alternaria is recognised as a source of sinus, nail, palatal, and ocular infections, especially Alternaria alternata . We report a rare case of tracheobronchitis Alternaria species in an immunocompromised patient. A 53-year-old female from Tabriz, Iran was referred to a central Hospital in Tabriz on June 24, 2014 (day 0). The patient presented with recurrent cough from 3 years ago, without sputum and blood that did cause dysphonia in this patient. She had a clinical history of 6 years (in April 2008) kidney transplantation and she was treated by immunosuppressive therapy consisting of tacrolimus (1 mg twice a day orally), and mycophenolate mofetil (500 mg triple a day orally). Her posttransplantation course was uneventful, but 3 years after the transplantation in 2011 year she had some times recurrent A Rare Case of Tracheobronchitis Alternariosis in a Renal Transplant Recipient