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Alternaria is a very common and saprophytic fungus. Cutaneous infection is rare and about 71 cases have been described, mainly in Europe in immunocompromised hosts. We report a case of dermal alternariosis occurring in a woman treated with corticosteroids for dermatomyositis. The cutaneous lesion consisted of an erythematous and scaly plaque on the leg measuring 2 x 2 cm. Cutaneous biopsy showed hyphae and round inclusions stained with PAS and Gomori-Grocott within a polymorphous granuloma. Cultures of cutaneous biopsies grew Alternaria sp. HIV1 and HIV2 serology was negative. The patient was treated by local excision and corticosteroids were decreased. One-year follow-up showed no recurrence. Cutaneous alternariosis is an opportunistic infection. the disease has been described mainly in patients treated with systemic corticosteroids (39 cases out of the 71 reported cases) or local corticosteroids (3/71) and in patients suffering from Cushing's syndrome (7/71) but rarely in HIV-infected patients (3/71). Cutaneous fragility induced by hypercorticism is an important cofactor permitting direct inoculation from the environment.

Alternaria is a very common fungus. Its pathogenic role in human pathology is mainly expressed by asthma. Cutaneous infection is rare and only about 70 cases have been described. Because of its wide distribution in the environment, cutaneous biopsy is necessary to ensure the diagnosis. We report two cases of dermal alternariosis occurring in the course of pemphigus treated with immunosuppressive therapy. Histological examination revealed a hyperplasic epidermis. The upper dermis showed a mixed inflammatory infiltrate with neutrophils, histiocytes and giant cells. Round intracytoplasmic inclusions staining faintly with PAS wer seen in giant cells. Long intercellular filaments were present in the infiltrate. This histopathological aspect is not specific, and cultures of both cutaneous biopsies were necessary. The association of dermal alternariosis and pemphigus is explained both by the immunosuppressive therapy for pemphigus and by the cutaneous fragility induced by the acantholytic disease permitting direct inoculation of Alternaria.