CASE REPORT Neurological and multiple organ involvement due to Paracoccidioides brasiliensis and HIV co-infection diagnosed at autopsy Sergio Monteiro de Almeida 1,2,3,4,5 & Thiago H. Roza 1 & Gabriel L.O. Salvador 1 & João C.B. França 6 & Luine Rosele Renaud Vidal 2 & Meri Bordignon Nogueira 2 & Lubomira Veronica Oliva 1 & Luis Fernando Bleggi Torres 1 & Lucia Helena de Noronha 1,7 Received: 27 June 2017 /Revised: 4 August 2017 /Accepted: 24 August 2017 # Journal of NeuroVirology, Inc. 2017 Abstract Paracoccidioidomycosis (PCM), caused by Paracoccidioides brasiliensis, is the most prevalent system- ic mycosis among immunocompetent patients in Latin America; it is rare in immunocompromised patients. The estimated frequency of central nervous system (CNS) in- volvement in the HIV/PCM population was 2.5%. We re- port a case of HIV/P. brasiliensis co-infection, with neuro- logical (NPCM) and multiple organ involvement, indicating a diagnosis of AIDS. PCM diagnosis was established during the autopsy. This is the first described case of HIV/ P. brasiliensis co-infection with CNS involvement diag- nosed at autopsy. In conclusion, the diagnosis of NPCM is challenging, and it must be considered in the differential diagnosis in HIV-positive patients who reside in or have visited areas in which the condition is endemic and who present with neurological symptoms. Keywords Central nervous system . Co-infection . HIV . Neuro-paracoccidioidomycosis . Paracoccidioides brasiliensis . Paracoccidioidomycosis Introduction Paracoccidioidomycosis (PCM) is an autochthonous disease in the region stretching from southern Mexico to northern Argentina (Shikanai-Yasuda et al. 2006). It is caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. Co-infection with HIV and P. brasiliensis is not frequent, was estimated at 0.09% in AIDS patients in Brazil (Goldani and Sugar 1995). Typically, HIV-positive patients develop severe acute/subacute disseminated PCM disease (Shikanai- Yasuda et al. 2006). It is unclear whether P. brasiliensis infec- tion in immunosuppressed patients represents a new infection or re-activation of a chronic, latent infection (Benard and Duarte 2000). We report a case of HIV/P. brasiliensis co-infection, with disseminated acute/subacute PCM, and multiple other co- infections as the first manifestation of AIDS. To date, only four cases of neuro-paracoccidioidomycosis (NPCM) in HIV-positive patients have been reported, all from Brazil (Colombo et al. 1989; Guimarães et al. 1991; Finamor et al. 2002; Silva-Vergara et al. 2014). The NPCM diagnosis was established in an HIV/P. brasiliensis co-infection case by au- topsy for the first time. Case report A 30-year-old Caucasian man, who was a bricklayer but was currently unemployed and had no history of involvement in * Sergio Monteiro de Almeida sergio.ma@ufpr.br 1 Medical Pathology Department, Medicine School, Universidade Federal do Paraná, Curitiba, Paraná, Brazil 2 Virology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil 3 Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil 4 Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil 5 Hospital de Clínicas—UFPR, Seção de Virologia, Setor Análises Clínicas, Rua Padre Camargo, 280, Curitiba, PR, Brazil 6 Infectious Diseases Unit, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil 7 Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil J. Neurovirol. DOI 10.1007/s13365-017-0577-1