RESUMO
Alternaria species are ubiquitous dematiaceous fungi that are increasingly recognized as pathogens in immunocompromised patients or those with significant underlying disease, but they are also pathogens in otherwise healthy hosts. We describe a case of dermal cutaneous ulcerative alternariosis in a frail 83-year-old patient with diet-controlled diabetes mellitus. Histological analysis revealed hyphal morphology in tissue sections that was initially confused with that of a zygomycetous fungus, and multiple positive culture results were necessary to identify the organism. Treatment with oral itraconazole and surgical debridement were ineffective; clinical improvement was achieved by means of treatment with intravenous amphotericin B lipid complex. We review the literature regarding the role of diabetes mellitus in cutaneous alternariosis and regarding the efficacy of treatment with itraconazole, which has been used very successfully. To our knowledge, this is only the second case report noting diabetes mellitus uncomplicated by steroid administration as a possible predisposing factor for cutaneous infection.
Assuntos
Alternaria , Antifúngicos/uso terapêutico , Complicações do Diabetes , Itraconazol/uso terapêutico , Úlcera da Perna/tratamento farmacológico , Micoses/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Alternaria/isolamento & purificação , Feminino , Humanos , Úlcera da Perna/complicações , Úlcera da Perna/microbiologia , Úlcera da Perna/patologia , Micoses/complicações , Micoses/microbiologia , Micoses/patologia , Falha de TratamentoRESUMO
On April 5, 1993, a China Eastern MD-11 underwent three violent pitch-up maneuvers, injuring over 100 passengers. The pilot made an emergency landing at 3:20 a.m. at Shemya, a tiny Aleutian Island with minimal medical facilities and personnel. The author describes their medical response, problems encountered and lessons learned.