Diffuse Lung Disease: Diffuse Lung Disease |

Lymphoid Interstitial Pneumonia: An Uncommon Interstitial Lung Disease Commonly Seen in HIV FREE TO VIEW

Khalid Sherani, MD; Abhay Vakil, MD; Aniket Sharma, MD; Kelly Cervellione, MSHP; Craig Thurm, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A193. doi:10.1016/j.chest.2016.02.200
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SESSION TITLE: Diffuse Lung Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Lymphoid interstitial pneumonia (LIP) is an uncommon disease characterized histopathologically by alveolar interstitial infiltration with lymphocytes, plasma cells and other lymphoreticular elements along with involvement of interlobular septa and sub-pleural areas. It presents in approximately 3% HIV positive patients and is considered an AIDS-defining illness most frequently diagnosed at autopsy. We report the case of a 49-year-old non-smoker female presenting with dyspnea and productive sputum. Imaging studies showed bilateral ground-glass opacities. Histopathologic examination confirmed LIP. She was found to be HIV positive on subsequent testing.

CASE PRESENTATION: A 49-year-old non-smoker female presented with dyspnea and productive cough for 2 days. She denied hemoptysis, leg edema and having any environmental, social or occupational risk factors for HIV. On examination, she was afebrile, tachypneic (22 breaths/min), tachycardic (102 beats/min) and hypoxic (85% on room air). Imaging studies showed diffuse bilateral ground glass opacities (Fig. 1a) with septal thickening and non-specific ill-defined nodules. The patient was placed on high flow oxygen therapy, cultured and started on empiric antibiotic therapy. Bronchoscopy with lavage failed to reveal any infectious etiology. Histopathologic examination showed lymphocytic infiltration of the bronchial wall and the interstitium with expansion of the alveolar septa (Fig. 1b and 1c) suggestive of LIP. Patient was started on steroid therapy. Due to frequent association of LIP with autoimmune and rheumatologic disorders, further serologic testing was performed. The patient was found to be HIV positive, requiring antiretroviral therapy leading to rapid improvement in her symptoms.

DISCUSSION: LIP is an uncommon lymphoproliferative pulmonary disorder, mostly found in individuals with HIV, hypergammaglobulinemia, Sjögren’s disease and other autoimmune conditions. The exact incidence and prevalence are unknown. Radiologically it is characterized by ground glass opacities, centrilobular nodules and septal thickening with cystic changes seen in later stages of the disease. The optimal treatment for LIP is unknown. Most patients with underlying HIV respond to antiretroviral therapy. Long term steroid therapy with is usually recommended in non-HIV patients. Premature steroid taper is the most common cause of relapse with about 20% patients requiring immunosuppressant therapy. Malignant transformation has been documented in about 5% cases.

CONCLUSIONS: It is important to recognize HIV as one of the risk factors for LIP with antiretroviral therapy resulting in rapid improvement of HIV-associated LIP.

Reference #1: Innes AL et al. Resolution of lymphocytic interstitial pneumonitis in an HIV infected adult after treatment with HAART. Sex Transm Infect. 2004;80(5):417.

DISCLOSURE: The following authors have nothing to disclose: Khalid Sherani, Abhay Vakil, Aniket Sharma, Kelly Cervellione, Craig Thurm

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