Disseminated Phaeohyphomycosis Due to Alternaria alternata in a Liver Transplant Recipient: Successful Treatment With Isavuconazole, a Case Report and Literature Review

Abstract

Phaeohyphomycoses are a heterogeneous group of diseases caused by several genera of pigmented fungi, also called dematiaceous fungi. These organisms are increasingly recognized as emerging opportunistic pathogens in immunocompromised patients, particularly solid organ transplant recipients. Among them, Alternaria is the most frequently associated genus, with clinical manifestations ranging from superficial to disseminated infections. Treatment options are limited and often complicated by toxicity and drug interactions, particularly in the posttransplant setting. We report what is, to our knowledge, the first case of disseminated alternariosis in a liver transplant recipient in Uruguay, successfully treated with isavuconazole. This case highlights the importance of early recognition and tailored antifungal therapy in transplant patients presenting with unusual cutaneous and pulmonary manifestations.