Paracoccidioides brasiliensis causing a rib lesion in an adult AIDS patient.
Paracoccidioidomycosis is a systemic mycosis with a geographic distribution that is limited to Central and South America; Brazil has the highest number of cases. Severe disseminated disease caused by paracoccidioidomycosis was observed in acquired immunodeficiency syndrome patients who live or have resided in endemic paracoccidioidomycosis areas. Here we describe a male patient admitted to a large public hospital with diffuse nodular infiltrates observed in chest radiographs and with erosion at the second rib near the sternum. Blood tests showed anti-human immunodeficiency virus antibodies, a human immunodeficiency virus viral load of 59,700 (4.8 log), and CD4 144/mm(3), with negative serology result for fungal infections. Aspirate of the rib lesion showed cells with a typical morphology of Paracoccidioides brasiliensis, aside from benign inflammatory cells. The histology of the rib biopsy showed typical granulomas and immunostained fungal cells. Although there was no growth in the Sabouraud cultures, Paracoccidioides brasiliensis gp43 and rDNA genes were detected in the aspirate by polymerase chain reaction. Therapy with amphotericin resulted in complete recovery. This type of bone lesion is rare and has been described primarily in the juvenile form of paracoccidioidomycosis; it must be included in the differential diagnosis of bone lesions in adult acquired immunodeficiency syndrome patients of endemic areas.
de Freitas
Roseli Santos
RS
Laboratório de Micologia Médica do Instituto de Medicina Tropical de São Paulo e Laboratório de Investigação Médica em Micologia (LIM) 53/HCFMUSP, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) 05403-000, São Paulo, Brazil.
Dantas
Kátia Cristina
KC
Garcia
Roberta Scholz Pinto
RS
Magri
Marcello Mihailenko Chaves
MM
de Andrade
Heitor Franco
HF
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001850:Bone Diseases, Infectious / Q000188:drug therapy / Q000382:microbiology*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D004269:DNA, Bacterial / Q000032:analysis; D004275:DNA, Ribosomal / Q000032:analysis; D004359:Drug Therapy, Combination; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010228:Paracoccidioides / Q000235:genetics / Q000302:isolation & purification*; D010229:Paracoccidioidomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012272:Ribs; D013411:Sulfadiazine / Q000627:therapeutic use; D016896:Treatment Outcome; D019562:Viral Load
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D013411:Sulfadiazine; D017964:Itraconazole; D000666:Amphotericin B