Bone Paracoccidioidomycosis in an HIV-Positive Patient

AIDS patients are vulnerable to infection by opportunistic microbes, including various fungi such as Pneumocystis carinii, Cryptococcus neoformans, Histoplasma capsulatum, Candida albicans and many others. However, the association of AIDS and infection with Paracoccidioides brasiliensis has been rarely recorded. We report a case of an HIV-positive patient with bone infection by this fungus with a clinical form not previously published. This clinical presentation included primarily a massive bone lesion, but it did not include the lymphatic and disseminated disease described in HIV-positive patients. The patient responded well to medical and surgical treatment. We suggest that patients with moderate, rather than severe, immunosuppression may have forms of paracoccidioidomycosis with a pathologic process intermediate to those seen in the immunologically normal host and the full AIDS syndrome.