Disseminated Paracoccidioidomycosis and Coinfection with HIV

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 . . .