Brainstorming some ideas here:
- Alexander lives longer, conquers Arabia and Carthage.
- Alexander Molassus of Epirus lives longer, conquers Italy south of Samnia. Maybe Sicily, too. Nominally allied with Rome against the Samnites, thus saving the Republic from the eager eyes of his nephew Alexander the Great. Sicily gets conquering by one Alexander or the other.
- As Alexander's Empire breaks up after his death, the gains of the Epirote Kingdom are incorporated, leaving a Diodochi state composed of N. Africa, Sicily, Southern Italy, and Epirus.
- Said state goes to war with Rome, may as well be under a king name Pyrhhus. Fun ensues.