A 28-year-old male from Santarem, Para, Brazil, with a history of leisure activities in a rural area, tractor driver, a known carrier of the HIV virus since 2010, however without previous follow-up, contacted us for the first time at Fundacao de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil, for investigation of left knee chronic monoarthritis associated with tegumentary lesions. He had been using zidovudine, lamivudine, lopinavir/ritonavir for three weeks, this being the first antiretroviral regimen used. He had never used prophylactic trimethoprim-sulfamethoxazole. He denied being a smoker or alcohol user. He reported that the left knee arthritis appeared after local trauma identified five months before, preceding the tegumentary lesions that appeared two months after the fact. During the clinic exam, polymorphism of skin lesions was noted with pustules of follicular distribution, papules with central necrosis, erythematous-infiltrated plaques covered with pustules and ulcerated plaques, located on the face, trunk, abdomen and limbs, associated with left knee arthritis (Figures 1, 2 and 3A). Oral and genital mucosa were spared. Lymphadenopathy and hepatosplenomegaly were not observed. Blood cultures for aerobes, mycobacteria, fungi and leukocyte cream were negative. VDRL resulted non-reagent. The Leishmaniasis screening exam was negative. The analysis of synovial fluid suggested infectious arthritis. Left knee x-ray showed reduction of joint space and osteolytic patellar lesion (Figure 3B). Patient underwent surgical cleansing of joint, biopsy of synovial membrane and skin. Both exams identified round cells, birefringent, with multiple buddings compatible with P. brasiliensis (Figure 4). Culture of synovial tissue confirmed the finding. Complementary propedeutics suggested pulmonary involvement and the Xpert/MTB RIF  sputum test was negative. At the time of diagnosis T CD4+ count was 44 cells/mm3 . Patient was treated with Amphotericin B deoxycholate 50mg/day (cumulative dose of 650mg) but despite the therapy, his clinical condition worsened, progressing to death on the 20th day of hospitalization. Necropsy revealed involvement of lungs, liver, spleen, kidneys, adrenals and bone marrow, in addition to the previously described sites (Figure 5).