PURPOSE: To establish the etiology of Solitary pulmonary nodules (SPN) in Human Immunodeficiency Virus (HIV)-infected patients and to determine the efficacy of diagnostic tests used.
METHODS: A retrospective study was done in a busy inner city hospital in Bronx, NY, which is a Designated AIDS center and provides care to more than 1000 HIV-infected patients every year. A chart review was done for all HIV infected patients admitted to the hospital between 2000 and 2009. Ten HIV-infected patients with newly diagnosed SPN admitted between 2000 and 2009 were identified. All the microbiological and histopathological specimens obtained from sputum, bronchoalveolar lavage and biopsies (transbronchial, CT guided Percutaneous Transthoracic Needle Biopsy (PTNB) and open lung) were analyzed. In addition, studies like Fludeoxyglucose (FDG) uptake done for the evaluation of SPN were assessed.
RESULTS: From January 2000 until December 2009 (Total of 10 years); a total of 5000 HIV patients with Chest X-ray or chest CT were admitted, of those only 10 patients were found to have SPN. Among these 10 patients, 6 had a definite diagnosis. Infection was the underlying etiology in 5 patients (3 patients had infection from Candida species, 1 had Tuberculosis, and 1 had infection from Cryptococcus neoformans); Lung Adenocarcinoma was diagnosed in 1 patient and etiology was unidentified in the rest. Sputum analysis was of no diagnostic value in any of these cases. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy were diagnostic in 3 cases, CT guided percutaneous transthoracic needle biopsy was diagnostic in 2 cases and 1 patient required open lung biopsy.
CONCLUSION: Unlike in immunocompetent patients, etiologies of SPN in HIV-infected patients are varied and difficult to predict. Infectious etiology is the most common cause.
CLINICAL IMPLICATIONS: It is difficult to predict the etiology of SPN in HIV-infected patient. Since there is no sensitive or specific non-invasive test, biopsy, either transbronchial, CT guided PTNB or Open lung is needed for the diagnosis.Sputum analysis is of no diagnostic value in the diagnosis of SPN in HIV-infected patients.
DISCLOSURE: Vikas Pathak, No Financial Disclosure Information; No Product/Research Disclosure Information