Isolation of Alternaria alternata in an HIV-Positive Patient: Emerging Pathogen or Opportunistic Colonizer?

We report a case of a person living with HIV presenting chronic dorsal-nuchal lesions resembling mycosis but distinct from common fungal infections. The lesions showed abundant exudate, dark brownish borders, and ulceration. Microscopic examination and cultures on SDA and DTM media identified Alternaria alternata , a rare opportunistic pathogen mostly affecting immunocompromised patients. Notably, the patient had well-controlled HIV (RNA < 50 copies/ml) and a CD4 + count > 500 cells/mm³. This case highlights that rare fungal infections remain a risk for potentially vulnerable individuals, even under effective HIV treatment.