A 35-year-old woman who used parenteral drugs was diagnosed with HIV and HCV infection and was on high-resolution antiretroviral therapy.
On two occasions (for 4 months and 1 month), and in relation to drug consumption (heroin), she presented episodes of candidiasic folic acid and costume of 2nd right costal arch respectively.
He was treated with fluconazole 400 mg/day for 2 weeks, requiring resection of the costal cartilage and fistula.
Upon admission, in the anamnesis, the patient explained a clinical picture, of a week of evolution, of quantified cough with purulent expectoration, left thoracic pain of pleuritic characteristics, loses mechanical pain characteristic of localized dorsal level.
On physical examination, the patient did not present any signs of pneumonia, with emphasis on the semiology of lower 1/3 of left hemothorax and pain upon palpation of the spinous process of the last dorsal vertebra and first lumbar vertebrae.
Leukocytes 11,800 (67% N), hemoglobin 10.6, hematocrit 34, MCV 123 and platelets were normal.
SGA of 117 mm in the first hour.
Routine biochemical parameters, coagulation and elemental urine analysis showed no alterations.
The determinations of CD4 lymphocyte subpopulations were 944/mm3 and the HIV viral load was undetectable.
In microbiological studies, blood cultures and serology of brucella were negative.
No vegetations were found in the echocardiographic examination.
The chest X-ray showed an image of radioopacity in the left lower lobe with associated pleural effusion.
Microbiological studies of sputum were sterile with negativity for AFB and, in pleural fluid (exudated) culture was positive for mononuclear AFB.
In the dorsolumbar Tac, signs of stenosis Lpondylodiscitis were found, affecting both bodies D-11, D-12-1, spinal cord interspaces D11-D11 and spinal cord interspaces D11-D
Direct puncture of the mass was performed.
Purulent material was obtained and in the microbiological study AFB determination was negative and culture positive for Candida albicans.
Orthosic measures were established and sequential treatment with liposomal amphotericin B at a dose of 150 mg/day for 20 days, followed by fluconazole 400 mg/day for a total of 6 months, evolving with clinical and radiological improvement.
Table I shows several characteristics of both cases.
