Paracoccidioidomycosis (PCM) has been rarely reported among HIV patients, despite being an endemic mycosis in South America. For this reason we report a clinical case of PCM presenting as first clinical manifestation of HIV/AIDS. A female patient , 34-y-old, born in Porlamar, Margarita Island, Venezuela, presented persistent cough with dyspnea and asthenia, of 5 months of evolution, sometimes fever (39oC); she received previously different antimicrobial treatments. No significant personal medical history. At income, physical examination: BP 110/70mmHg, HR: 90bpm, RR: 25bpm, T.37ºC. She presented in regular general conditions, hydrated, mild mucocutaneous paleness, caquetic. Cardiopulmonary evaluation revealed respiratory sounds in both hemithorax, with ronchus and bulous sounds in both sides. Rest physical examination without apparent alterations. Income diagnosis: Bronchopneumoni a; TB to be rule out. Patient begun to receive Azithromycin 500mg po od x 5d. IgG serology for Chlamydophila pneumoniae was positive (1:32 dil), IgM for Mycopl asma pneumoniae negative. TB studies were all negative. Due t o dyspnea Hydrocortisone is given at 100mg VEV q6h x3d. Mycology serology was positive for Paracoccidioides brasiliensi s, after this itraconazole is given at 100mg pood x 6 months. Hydrocortisone was omitted. HIV ELISA was positive, confirmed by Western-blot . No hematological or lymphocytic alterations were observed up to this moment. HIV infection and endemic tropical diseases interaction has become a major concern, but i t s mechani sms are still poorly understood. PCM, a South America endemic deep mycosis, may provide an interesting model to investigate this, as features of most HIV-PCM-coinfected patients are difficult to classify into standard acute and chronic PCM forms.
2007-10-19 | 1,119 visitas | Evalua este artículo 1 valoraciones
Vol. 38 Núm.1. Octubre 2007 Pags. 27-28 Rev Soc Med Quir Hosp Emerg Perez de Leon 2007; 38(Supl. 1)