SHM Converge Scientific Abstract ePoster Gallery-Consider the Alternatives: A Case of Cutaneous Alternaria Infection and Tenosynovitis

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This case describes a 76-year-old kidney transplant recipient on tacrolimus and prednisone who developed painful swelling and bullae of the left fourth and fifth digits while hospitalized for Nocardia abscesses. Exam showed exquisite tenderness, erythema, edema, and limited motion. Imaging and biopsy revealed cutaneous Alternaria infection with associated tenosynovitis.<br /><br />Workup included ultrasound, MRI, and skin biopsy. MRI showed fluid and edema around extensor tendons, while biopsy demonstrated fungal organisms consistent with Alternaria species; fungal culture was positive. Hand surgery recommended conservative treatment rather than operative intervention.<br /><br />Alternaria is a soil-dwelling fungus and a rare cause of infection, usually seen in immunocompromised patients, especially solid organ transplant recipients or those on chronic corticosteroids. Most infections are cutaneous and can appear as erythematous or verrucous lesions, but presentations vary.<br /><br />The patient improved and symptoms resolved after a three-month course of posaconazole 300 mg daily. The report emphasizes that in immunocompromised patients with skin and soft tissue infections, clinicians should consider atypical pathogens such as fungi and obtain early skin biopsy to evaluate for bacterial, fungal, viral, and parasitic causes. Management may include reducing immunosuppression and using antifungal therapy such as itraconazole or posaconazole.

Asset Subtitle

Anna Clemens

Meta Tag

Author List Anna Clemens, Daniel Montes, Diego Suarez

Category Clinical Vignettes

Concept Alternaria

Concept Skin and Soft Tissue Infection

Concept Immunocompromised State

Concept Skin Biopsy

Concept Fungal Culture

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Anna Clemens

Track Adult

Keywords

Alternaria infection

kidney transplant

immunocompromised

cutaneous fungal infection

tenosynovitis

posaconazole

tacrolimus

prednisone

skin biopsy

Nocardia abscesses

Alternaria

Skin and Soft Tissue Infection

Immunocompromised State

Skin Biopsy

Fungal Culture