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Diffuse Lung Disease |

Pulmonary Sarcoidosis in the Setting of HIV Disease

Theingi Win, MBBS; Penelope Scott, MD
Author and Funding Information

MedStar Good Samaritan Hospital, Baltimore, MD


Chest. 2014;145(3_MeetingAbstracts):231A. doi:10.1378/chest.1829889
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Abstract

SESSION TITLE: ILD Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

PURPOSE: 1. Pulmonary sarcoidosis in HIV patients mimics other ILDs. 2. High suspicion of sarcoidosis in HIV patients is important since early diagnosis and appropriate therapy usually results in excellent outcome. 3. Diagnosis of sarcoidosis in HIV patients requires exclusion of other chronic infection/inflammation or malignant causes.

METHODS: Case report

RESULTS: A 39 year old African American female with HIV/AIDS on HAART presented with bilateral parotid swellings, non-productive cough, subjective fevers and chills. She was hospitalized with bilateral pneumonia 3 months ago and discharged home with ciprofloxacin without resolution of her symptoms. A follow-up CXR showed persistent pulmonary infiltrates. Her last absolute CD4 count was 768 3 month ago with viral load of <20. A contrast chest CT and head showed bilateral parotid swellings, bilteral hilar and mediastinal lymphadenopathy with multiple small nodules, worse at bases on a background of ground glass appearance. An extensive work up for infectious etiology was entirely negative. Bronchoscopy with BAL with cytology demonstrated non-caseating granuloma consistent with sarcoidosis and no evidence of infectious pathogens or malignancy. She was started on prednisone 40mg p.o. daily with significant improvement in her symptoms.

CONCLUSIONS: Sarcoidosis is characterized by accumulations of activated T cells and macrophages at sites of disease activity. Sarcoid T lymphocytes belong to the helper CD4 phenotype. Although the exact etiology of sarcoidosis remains elusive, studies suggest that the granulomatous inflammation of sarcoidosis develops under the regulatory influence of cytokines produced by T cells and other local mononuclear phagocytes. Sarcoidosis in HIV patients is relatively rare. There are a few similar case reports of worsening previously diagnosed pulmonary sarcoidosis in HIV patients after starting HAART therapy. This phenomenon may be a manifestation of Immune reconstitution inflammatory syndrome (IRIS). Whether sarcoidosis represents a manifestation of IRIS or simply occurs in susceptible individuals who have concomitant HIV infection is unclear.

CLINICAL IMPLICATIONS: Presented is a case of newly diagnosed pulmonary sarcoidosis in HIV patient already on HAART therapy for more than a year with stable immune system.

DISCLOSURE: The following authors have nothing to disclose: Theingi Win, Penelope Scott

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