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Introduction <p>Opportunistic fungal infections are commonly associated with advanced immunosuppression in people living with HIV (PLWH). However, rare and atypical fungal pathogens may still occur even in patients with well-controlled infection and preserved immune function.<i> Alternaria alternata </i>is a dematiaceous environmental fungus that only rarely causes cutaneous and subcutaneous disease, typically in immunocompromised hosts.</p> Case Presentation <p>We report the case of a person living with HIV who presented with chronic skin lesions clinically resembling mycosis but showing atypical features, including abundant exudate, dark brownish borders, and ulceration. Direct microscopic examination and fungal cultures performed on Sabouraud Dextrose Agar (SDA) and Dermatophyte Test Medium (DTM) led to the identification of <i>Alternaria alternata</i>. Notably, the patient’s HIV infection was well controlled, with plasma HIV-RNA &lt; 50 copies/mL and a CD4⁺ T-cell count &gt; 500 cells/mm³, and no other evident causes of immunosuppression were identified.</p> Conclusions <p>This case highlights that rare opportunistic fungal infections can occur even in PLWH with effective antiretroviral therapy and apparently preserved immune status. Clinicians should maintain a high index of suspicion for uncommon fungal pathogens when facing atypical cutaneous lesions, regardless of virological suppression and CD4⁺ count, underscoring the need for thorough mycological investigation in selected cases.</p>

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

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Mirko Benvenuti,
  • Lucia Taramasso,
  • Silvia Francesca Riva,
  • Antonio Di Biagio,
  • Emanuele Claudio Cozzani

摘要

Introduction

Opportunistic fungal infections are commonly associated with advanced immunosuppression in people living with HIV (PLWH). However, rare and atypical fungal pathogens may still occur even in patients with well-controlled infection and preserved immune function. Alternaria alternata is a dematiaceous environmental fungus that only rarely causes cutaneous and subcutaneous disease, typically in immunocompromised hosts.

Case Presentation

We report the case of a person living with HIV who presented with chronic skin lesions clinically resembling mycosis but showing atypical features, including abundant exudate, dark brownish borders, and ulceration. Direct microscopic examination and fungal cultures performed on Sabouraud Dextrose Agar (SDA) and Dermatophyte Test Medium (DTM) led to the identification of Alternaria alternata. Notably, the patient’s HIV infection was well controlled, with plasma HIV-RNA < 50 copies/mL and a CD4⁺ T-cell count > 500 cells/mm³, and no other evident causes of immunosuppression were identified.

Conclusions

This case highlights that rare opportunistic fungal infections can occur even in PLWH with effective antiretroviral therapy and apparently preserved immune status. Clinicians should maintain a high index of suspicion for uncommon fungal pathogens when facing atypical cutaneous lesions, regardless of virological suppression and CD4⁺ count, underscoring the need for thorough mycological investigation in selected cases.