Background: It is shown the retrospective analysis of 26 patients (21men/5women) infected with HIV and simultaneous diagnosis of tuberculosis and disseminated histoplasmosis (DH). The patients were seen in the Hospital La María and at the Corporación para Investigaciones Biológicas in Medellín, Colombia. Methods: The diagnosis of TB was made by histopathology in 13 cases, direct examination of sputum smears for acid-fast-bacilli in 8 cases, culture in 8 cases and BAL direct examination in 3 cases. The diagnosis of DH was made exclusively by histopathology in 8 patients, BAL direct examination in 4 cases and simultaneous direct examination and culture in 10 cases. Results: The evolution time of the HIV infection was of 33 months (0-144), with T CD4 lymphocytes count of 55 (3-152) cl/ul and viral load of 256 copies/ul (400-1.000.000). At the moment of the consultation only 8 (30,8%) of the patients had received HAART. The evolution time of the symptoms was of 74 days (7-270) and the most frequently compromised organs were the lungs in 17 patients (65%), followed by the lymph-nodes in 10 (38%), bone marrow in 3 (11,5%), liver in 3 (11,5%) and the intestine in 2 (7,6%). Nineteen of the patients (73%) received Amphotericin-B as initial treatment, followed by Itraconazole. It was performed a monitoring of the Itraconazole serum levels, which were not detectable in 8 of 10 patients at the beginning and in 4 of 5 patients in positive controls. It was used a conventional anti-TB treatment with rifampicin, isoniazide, pyrazinamide and ethambutol. The assessment of the therapeutic response was performed after 15 days, 1 and 3 months, finding improvements in 64%, 75%, and 77% respectively, and no improvement in 32%, 21% and 10% respectively. Mortality was present in 1 patient with the first two controls and 3 at the third month (16%). Conclusion: This underlines the importance of considering TB in association with endemic mycoses such as DH, in severe-immunocompromised-HIV patients from third-world countries. This diagnosis is only possible after clinical suspicion and the performance of adequate laboratory tests. The association of these infections makes therapy difficult and increase mortality risk. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive