The present report describes a case of cutaneous protothecosis caused by Prototheca wickerhamii in a nonimmunocompromised Brazilian female. Dermatological examination revealed a 15-cm diffusely infiltrated eczema-like plaque recovered with many pustule-like lesions on the right forearm. We emphasize the mycological and pathological aspects of this infection that can lead to misdiagnosis. The patient was successfully treated with itraconazole.

The present report describes a case of onychoprotothecosis caused by Prototheca wickerhamii in a nonimmunocompromized female. Dermatological examination showed yellowish discoloration of the left and right forefinger nails, showing onicolysis and hyperkeratosis. The repeated isolation of the algae Prototheca (organisms morula-like) as well as the repeated culture in media, Sabouraud agar, confirmed the diagnosis. The patient was successfully treated with tioconazol 1% topic solution. The aim of this paper was to present a rare condition.

The considerable increase of the life expectancy of HIV-infected patients in the age of highly-powerful antiretroviral treatment results in important metabolic and bone-joint changes resulting from a long-lasting viral infection time and from this treatment. The most common orthopaedic complications are bone mineralization changes, osteonecrosis, carpal tunnel syndrome and gleno-humeral adhesive capsulitis, with different clinical presentation features, natural disease progression and therapeutic response compared to the overall population. Literature reports are initial, and the experience of the multidisciplinary service of the University of Sao Paulo's Institute of Orthopaedics and Traumatology enables us a more indepth knowledge about the various pathologies involved and the development of treatment protocols that are appropriate to these diagnoses.

RESUMOO aumento considerável da expectativa de vida dos pacientes infectados pelo HIV na era do tratamento antirretroviral de alta potência, resulta em importantes alterações metabólicas e osteoarticulares decorrentes do prolongado tempo de infecção viral e desse tratamento. As complicações ortopédicas mais frequentes são as alterações da mineralização óssea, a osteonecrose, síndrome do túnel do carpo e capsulite adesiva glenoumeral, com padrão de apresentação clínica, evolução natural da doença e resposta terapêutica diferentes daqueles da população geral. Os relatos da literatura são iniciais e a experiência do serviço multidisciplinar do Instituto de Ortopedia e Traumatologia da USP permite avanço no conhecimento das diversas patologias envolvidas e o desenvolvimento de protocolos de tratamento adequados a esses diagnósticos. Descritores -HIV; Ortopedia; Diagnóstico INTRODUçãOCom o aumento considerável da expectativa de vida dos pacientes infectados pelo HIV na era do tratamento antirretroviral (TARV) de alta potência, são observadas algumas consequências do prolongado tempo de infecção viral e desse tratamento. As consequências metabólicas ocorrendo nesse contexto são exploradas em várias publicações na literatura, principalmente a síndrome lipodistrófica. Atualmente, a observação crescente de alterações osteoarticulares nesses pacientes é objeto de estudo mais detalhado, no intuito da detecção de suas eventuais causas e abordagem terapêutica mais adequada.Dentre as complexas alterações metabólicas da infecção crônica pelo HIV e seu tratamento, observa-se diminuição da mineralização óssea em grande percentagem dos doentes, resultante de vários fatores presentes no próprio hospedeiro, no vírus e nos antirretrovirais (ARV). O osso é constantemente remodelado pelo sincronismo entre sua formação e reabsorção, que pode ser desregulado durante a infecção pelo HIV. Quando a mineralização óssea diminui, a osteopenia ocorre, podendo resultar em osteoporose.

A 29‐year‐old white woman was seen for the evaluation of an eruption on her neck and shoulder. She was being treated for human immunodeficiency virus (HIV) infection (blood CD4+ lymphocyte count, 187 cells/μL) with saquinavir, ritonavir, and nevirapine antiretroviral therapy. Two months previously, she had suffered from herpes zoster. The new lesions were located exclusively on the site of the herpes zoster scars. Clinical examination revealed slightly hypertrophic and hypochromic cicatricial lesions on the left cervical (c3, c4, c5) dermatome; in this area, there were many skin‐colored, umbilicated, isolated, 1–2 mm papules (Fig. 1). Histopathology of a papule showed changes typical of molluscum contagiosum (Fig. 2). The patient was treated with local application of 70% trichloroacetic acid with excellent results (Fig. 3). The lesions did not recur after 6 months of follow‐up. 1 Skin‐colored, umbilicated, isolated, 1–2 mm papules on the left cervico‐thoracic dermatome 2 Histopathology of a papule showing changes typical of molluscum contagiosum 3 Patient after treatment with local application of 70% trichloroacetic acid