Progressive disseminated histoplasmosis and paracoccidioidomycosis in an AIDS patient: case report

Abstract

The endemic mycoses histoplasmosis (HPM) and paracoccidioidomycosis (PCM) are frequently reported in Colombia. The former is considered an opportunistic mycosis in individuals with deficient cellular immune defenses, particularly in HIV infected patients. PCM, on the other hand, is more prevalent in the non immunocompromised population with the number of cases with the HIV- PCM association being rare. At present, no reports on HIV patients with simultaneous co-infection by Histoplasma capsulatum and Paracoccidioides brasiliensis resulting in disseminated disease had been informed. We present here the case of a male AIDS patient who upon hospital admission presented important deterioration of his general health status and exhibited numerous skin lesions that led to various differential diagnoses, a systemic mycosis among

them. Additionally, the patient lived in a rural region in Antioquia that is characterized as an endemic region

for histoplasmosis and paracoccidioidomycosis, as well as his occupation in illegal cocaine farming. The results of the various diagnostic laboratory tests that included isolation of both fungi from skin lesions, lymph node aspirates and/or BAL fluid, the histopathological observations of clinical specimens, and the proper clinical evaluation of the patient, led to the conclusion that the patient ́s HIV setting allowed co-existence of both mycoses probably due to the low number of the T CD4+ cells which interfered with the host´s immune defense mechanisms.