From the Divisions of Geographic Medicine and Infectious Diseases, Departments of Medicine, Pathology, and

A 31-year-old man with AIDS developed a necrotic lesion on his nasal septum due to Alternaria alternata. Excision and treatment with amphotericin B resulted in cure. This case expands the spectrum of opportunistic pathogens that infect patients with AIDS. Visceral and mucosal infections due to Alternaria have been reported in at least seven other patients. Alternaria is a ubiquitous filamentous fungus pri-marily recognized as a plant pathogen and soil sap-rophyte. Inhalation of spores can induce bronchial asthma and hypersensitivity pneumonitis (1-3]. Rarely,Alternaria can cause invasiveinfections, such as cutaneous alternariosis (1, 4-10], keratomycosis (11], paranasal sinusitis with osteomyelitis [12-15], granulomatous pulmonary nodule (16], and perito-nitis [17]. These infections have occurred in both pre-sumably healthy and immunocompromised hosts. We report a case of invasive alternaria infection of the nasal septum in a patient with the acquired im-munodeficiency syndrome (AIDS). This infection was cured by surgical resection and treatment with amphotericin B. Wealso review cases of mucosal and visceral alternaria infection reported in the literature. Case Report A 31-year-oldhomosexual man was admitted to the hospital with Pneumocystis carinii pneumonia and diffuse esophageal candidiasis. His total leukocyte count was 6,200 cells/mm", with an absolute lym-phocyte count of 434 cells/mm". The ratio of T helper to T suppressor lymphocytes was 1.2(normal 1.3-4.6). The patient's serum contained antibody to the human immunodeficiency virus detectable by enzyme-linked immunosorbent assay (Abbott, Received for publicationAugust11, 1986, and in revised for