Luis Fabiano scored two goals in the second half to put Brazil back in the match after Clint Dempsey and Landon Donovan had given the Americans the lead.
Brazil, which won its third Confederations Cup title, looked like a beaten team in the first half, creating little and being constantly stymied by the United States defense and goalkeeper Tim Howard.
But Fabiano started the comeback in the 46th minute as Brazil's "Beautiful Game" burst into life. The striker collected a pass from Ramires before turning and shooting past defender Jay DeMerit for his fourth goal of the tournament.
He added a fifth in the 74th, heading in a rebound after Kaka's cross was kicked against the crossbar by Robinho.
Dempsey, who also scored in the 2-0 semifinal win over Spain, gave the Americans the lead in the 10th minute by redirecting a cross from Jonathan Spector. Donovan added the second by finishing off some nice passing play with Charlie Davies on a fast counterattack in the 27th.
Spector started the unthinkable after only 10 minutes, running down the right and sending a low cross into the area. Dempsey, who had plenty of room to maneuver, raised his right leg and put just enough of a touch on the ball to alter the direction and send it past a diving Julio Cesar.
Donovan then got possession at his own end shortly after Maicon had sent in a corner for Brazil from the right. The United States midfielder ran up the middle, passed to Davies and then reclaimed the ball from his teammate before beating Julio Cesar.
The Americans appeared to get some luck in the 60th when Kaka headed a cross from Andre Santos to the near post. Howard stepped back into his goal and knocked the shot off the underside of the crossbar and then grabbed it safely in his arms.
Kaka yelled at the referee and his linesman, arguing that the ball has crossed the line before Howard was able to get to it, and television replays appeared to show he was correct.
In the third-place match, Spain rallied to beat host South Africa 3-2 in extra time in Rustenburg.
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Lineups: United States: Tim Howard, Jay DeMerit, Carlos Bocanegra, Oguchi Onyewu, Jonathan Spector, Ricardo Clark (Conor Casey, 88), Clint Dempsey, Landon Donovan, Charlie Davies, Jozy Altidore (Jonathan Bornstein, 75), Benny Feilhaber (Sacha Klejstan, 75). Brazil: Julio Cesar, Maicon, Luisao, Lucio, Andre Santos (Daniel Alves, 66), Felipe Melo, Gilberto Silva, Ramires (Elano, 67), Kaka, Robinho, Luis Fabiano.
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