Images in Clinical Medicine
Disseminated Paracoccidioidomycosis and Coinfection with HIV
N Engl J Med 2006; 355:2677December 21, 2006
- Article
A 32-year-old man infected with the human immunodeficiency virus (HIV) who had a CD4 count of 9 cells per cubic millimeter had a 9-month history of weight loss, with progressive weakness and numerous ulcerated lesions of various dimensions on the face (Panel A), trunk, and arms and legs. Hepatomegaly was also noted on physical examination. Radiographic examination revealed numerous rounded lytic lesions on the bones of the hands (Panel B), arms, legs, feet, and skull. A reticulonodular infiltrate was present in both lungs. Histopathological examination of a skin ulcer and culture of purulent discharge from the lesions revealed Paracoccidioides brasiliensis. Since paracoccidioides is susceptible to trimethoprim–sulfamethoxazole, the use of this medication as prophylaxis for Pneumocystis jiroveci infection may provide protection against paracoccidioidomycosis as well. Paracoccidioidomycosis is rare in HIV-infected patients, perhaps in part because of the use of trimethoprim–sulfamethoxazole as prophylaxis for pneumocystis infection, which this patient had not received. His paracoccidioidomycosis was treated with amphotericin B followed by 3 years of azole therapy, which resulted in a clinical cure. He also received antiretroviral therapy and did well for 9 years but eventually died from complications of advanced HIV infection, without any recurrence of the paracoccidioides infection.
Gleusa Castro, M.D.
Roberto Martinez, M.D.
University of São Paulo, 14048-900 Ribeirao Preto, Brazil
gcastro@hcrp.fmrp. usp. br - Citing Articles (2)
Citing Articles
1
Lucas Moretti Monsignore, Roberto Martinez, Marcelo Novelino Simão, Sara Reis Teixeira, Jorge Elias Jr, Marcello Henrique Nogueira-Barbosa. (2011) Radiologic findings of osteoarticular infection in paracoccidioidomycosis. Skeletal Radiology
CrossRef2
Silvio Alencar Marques, Rosangela M.P. Camargo, Luciana P.F. Abbade, Carlos Magno C.B. Fortaleza, Mariangela E.A. Marques. (2010) Paracoccidioidomycosis: an unusual presentation in a young girl disclosing an unnoted HIV-infection. Medical Mycology 48:1, 182-187
CrossRef
