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The Brief Case: Cutaneous ulceration associated with acalabrutinib treatment

Summary

A 72-year-old patient being treated with acalabrutinib for blood cancer developed a slowly growing skin ulcer on the thigh. Testing identified a fungal infection caused by Alternaria alternata, a mold found in soil and air. The patient was successfully treated with an antifungal medication called posaconazole, with the ulcer healing over one month. This case highlights that doctors should check for fungal infections in chronic skin wounds of patients taking BTK inhibitor medications.

Background

Acalabrutinib is a second-generation Bruton’s tyrosine kinase inhibitor used to treat B-cell malignancies with reported fungal infection rates. Alternaria species are dematiaceous molds that typically cause cutaneous infections in immunocompromised patients. This case describes the first reported cutaneous alternariosis associated with acalabrutinib treatment.

Objective

To report and characterize a case of cutaneous alternariosis in a patient receiving acalabrutinib and corticosteroid therapy. To highlight the importance of mycological investigation in chronic skin lesions during BTK inhibitor treatment.

Results

A 72-year-old patient with chronic lymphocytic leukemia treated with acalabrutinib presented with a progressive cutaneous ulceration on the right thigh. Mycological investigation identified Alternaria alternata species complex through ITS sequencing. The patient was successfully treated with posaconazole (300 mg daily) with lesion improvement after one month and no relapse at four months.

Conclusion

Clinicians should be aware that invasive mold infections including phaeohyphomycosis may occur with concomitant acalabrutinib and corticosteroid treatment. Any chronic ulcero-necrotic skin disease in immunocompromised patients should be investigated with mycological examination to prevent disseminated infection.
  • Published in:Journal of Clinical Microbiology,
  • Study Type:Case Report,
  • Source: PMID: 40071988, DOI: 10.1128/jcm.01583-24
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