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Pulmonary Nodules in a Patient With AIDS/HIV Infection: Is It Always Infection or Malignancy? FREE TO VIEW

Khalid Sherani, MD; Abhay Vakil, MD; Aashir Shah, MD; Kelly Cervellione, MSHP; Craig Thurm, MD; Viral Patel, MBBS
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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):A194. doi:10.1016/j.chest.2016.02.201
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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: Infections and malignancies are the most common etiologies for pulmonary involvement in patients with acquired immunodeficiency syndrome (AIDs)/HIV infection. Sarcoidosis as a complication of antiretroviral therapy is extremely rare. We report the case of a 56-year-old male, known to have AIDs/HIV infection, who presented with pulmonary symptoms and multiple pulmonary nodules with lymphadenopathy after starting anti-retroviral therapy.

CASE PRESENTATION: A 56-year-old non-smoker male, with recently diagnosed AIDs/HIV infection presented with worsening shortness of breath, dry cough and generalized malaise for 1 week. He was started on antiretroviral therapy about 4 weeks prior to his presentation. He was hemodynamically stable on examination. He appeared wellnourished without any peripheral lymphadenopathy. Physical examination revealed bilaterally scattered crepitations. Laboratory data failed to reveal any abnormality. His CD4 cell count prior to starting antiretroviral therapy was 456 cells/uL, which increased to 730 cells/uL over aperiod of 4 weeks. Imaging studies showed multiple bilateral pulmonary nodules without any evidence of cavitation (Fig. 1a) and hilar lymphadenopathy. He was started on broad spectrum antibiotics. Bronchoscopy with bronchoalveolar lavage failed to reveal any infectious etiology. Due to high suspicion for malignancy a transbronchial needle aspiration of the hilar lymphadenopathy as well as an open lung biopsy were performed. Histopathologic examination of the biopsies showed non-necrotizing granulomas (Fig. 1b) with negative stains for fungus and acid fast bacilli. Serum and urine fungal serologies were negative. The patient had elevated angiotensin converting enzyme levels (83 U/L). He was evaluated for extra-pulmonary involvement of sarcoidosis. Following a negative work up he was started on steroid therapy, after which he showed resolution of his symptoms and imaging findings.

DISCUSSION: The true incidence of sarcoidosis in patients with AIDs/HIV infection remains unknown. However, extensive literature review shows that very few cases of sarcoidosis have been reported in patients with AIDs/HIV infection. Most of the cases developed after the initiation of antiretroviral therapy. The clinical course, radiologic and laboratory findings as well outcomes in this group of patients are similar to those patients having sarcoidosis without HIV infection.

CONCLUSIONS: Sarcoidosis should be considered in the differential diagnosis of the patients with AIDs/HIV infection who present with pulmonary manifestations, especially after starting antiretroviral therapy.

Reference #1: Foulon G., Wislez M. et al. Sarcoidosis in HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy. Clin Infect Dis. (2004) 38(3):418-425.

DISCLOSURE: The following authors have nothing to disclose: Khalid Sherani, Abhay Vakil, Aashir Shah, Kelly Cervellione, Craig Thurm, Viral Patel

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