CONICET | Buscador de Institutos y Recursos Humanos

We describe the first report in Argentina of a patient with AIDS who had an atypical tinea corporis produced by M. gypseum. A 39-year-old white male diagnosed as HIV+ in August 1996 had developed a Pneumocystis carinii infection in December 1996 and bilateral chorioretinitis in April 1998. He received antiretroviral treatment with zidovudine, dideoxyinosine and Indinavir, and trimethoprim/sulphamethoxazole as P. carinii pneumonia prophylaxis. In June 1998 the man developed seborrhoeic dermatitis, oropharyngeal candidiasis and genital herpes. His viral load increased to 155 000 copies/mL with a decrease in CD4 to 125 cells/mL. Meanwhile, he presented erythematous, vesicular and granulomatous skin lesions with clear, lightly infiltrated edges on his lower legs. The skin surrounding the lesions was scaly and pruritic. The culture developed a fungus identified as M. gypseum based on morphological features . Based on laboratory findings, fluconazole treatment was started (200 mg/day). A slow regression of the lesions was observed after 2 months of treatment. A review of the literature showed five reported cases of tinea corporis caused by M. gypseum in subjects with AIDS, one in France9 and four involving Brazilians.6,7,10 All of these subjects presented extensive, scaly, circinated and erythematous lesions that were very resistant to treatment. In our case, however, the antifungal treatment with fluconazole was successful. The atypical clinical manifestations presented by our subject can be attributed to the deterioration of his immune system; although he was in a state of advanced immunosuppression and antiretroviral treatment was unsuccessful he experienced no relapses of the dermatophytosis before his death 1 year later.

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