case_images: PMC11286409_01
case_images: Clinical presentation of pigmented hyperkeratotic scaly plaques (green arrows) and verrucous ulcerated lessons on legs (red arrows) (A,B), and the scars of healed Chromoblastomycosis plaques (blue arrows) post therapy (C,D).
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case_images: fig1
case_images: A 46-year-old woman with a history of renal transplant 8 years ago, presented with dark, verrucous, and ulcerative lesions on both legs (Figures 1A,B). After 5 months of this regimen, complete resolution of the lesions was achieved confirmed via negative cultures and clinical improvement of the healed lesions (Figures 1C,D).
case_images: Direct microscopy using KOH 10% shows the thick-walled ovoid sclerotic cells (black arrow) along with septate hyphae (red arrow).
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case_images: fig2
case_images: Upon further assessment, microscopic examination of skin scrapings using potassium hydroxide (KOH) revealed the presence of septate hyphae and ovoid bodies with thick walls, known sclerotic or medlar bodies (Figure 2).
case_images: Presence of fly larvae within the lesions, confirming the diagnosis of myiasis.
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case_images: fig3
case_images: Notably, the presence of fly larvae in the lesions also led to a diagnosis of myiasis (Figure 3).
case_images: Pigmented septate hyphae with chains of ovate conidia with transverse and vertical septa: (A) sample from week 1 and (C) sample from week 2. Colonies of Alternaria grown on SDA with chloramphenicol media: (B) sample from week 1 and (D) sample from week 2.
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case_images: fig4
case_images: This confirmed the identity of the isolate as Alternaria species, demonstrating that both positive cultures were consistent with Alternaria species (Figure 4).
case_images: The phylogenetic tree generated with Clustal Omga using the Multiple Alignment Algorithm.
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case_images: fig5
case_images: Alternaria infectoria CBS 210.86 (NR_131263.1), Alternaria conjuncta CBS 196.86 (NR_135929.1), Alternaria rosae CBS 121341 (NR_136017.1), Alternaria oregonensis CBS 542.94 (NR_135935.1), and Alternaria ethzedia CBS 197.86 (NR_135928.1) were used in phylogenetic analysis and Aspergillus fumigatus ATCC 1022 (NR_121481.1) was taken as an out-group. A phylogenetic tree was generated with Clustal Omga using the Multiple Alignment Algorithm (Figure 5).