Cutaneous alternariosis due to Alternaria chlamydospora after bone marrow transplantation.

In June 1994, a 33-year-old man was diagnosed with chronic myelogenous leukaemia. In November 1995, he underwent an allogeneic BMT from an unrelated donor. Three months later, a slightly itchy erythematous papule appeared on his left leg. During the following days, 2 similar lesions developed on his left thigh and right arm (Fig. 1). The lesions increased a little in size and the centre of the lesions became necrotic and ulcerated. A biopsy specimen was obtained from the left leg and showed epidermal hyperplasia with discrete parakeratosis. In the reticular dermis a mixed acute and chronic interstitial, in£ammatory in¢ltrate was observed with several foci of necrosis. These areas of necrosis contained multiple branching septate hyphae, which formed acute angles, and multiple round and oval spores, both of which stained heavily with periodic acid-Schi¡ (PAS) and Gomori-Grocott stain. Some of the fungal elements invaded the vessel walls. In the subcutaneous tissue several foci of ¢brosis with similar fungal structures were present. A biopsy culture was performed on Sabouraud agar with chloramphenicol and was identi¢ed as A. chlamydospora (colonies growing rapidly, olivaceous-black, £u¡y conidiophores up to 150 mm long, 3 ^ 6 mm wide, pale brown). No alterations were found on the rays of the chest and paranasal sinuses. The patient was treated intravenously with amphotericin B at a dose of 1 mg/kg/day for 4 days, followed by a lipidic complex of amphotericin B (Abelcet1) for another 18 days at a dose of 5 mg/kg/day, with complete resolution of the lesions.