Lung Pathology: Student/Resident Case Report Poster - Lung Pathology I |

A Pathologically Proven Case of Lymphocytic Interstitial Pneumonia in an HIV-Infected Adult With an Undetectable Viral Load FREE TO VIEW

Sara Assaf, MD; David Stoeckel, MD
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Saint Louis University Hospital, St Louis, MO

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

Chest. 2016;150(4_S):795A. doi:10.1016/j.chest.2016.08.891
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SESSION TITLE: Student/Resident Case Report Poster - Lung Pathology I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Lymphocytic interstitial pneumonia (LIP) is on the spectrum of lymphoproliferative diseases and can affect the lungs. Although common in HIV-infected children, it is rarely reported in adults [1,2]. HIV-related LIP in an adult with an undetectable viral load has not been described. We hereby present the first case of a histopathologically proven diagnosis of LIP in an infected adult with sustained viral response

CASE PRESENTATION: A 51 year old HIV infected female patient presented with worsening dyspnea over five months. Physical examination revealed an oxygen saturation of 96% on room air and normal lung exam. Diagnostic work up included normal basic labs, a CD4 count of 835 and an undetectable HIV viral load. An ABG revealed hypoxemia and her A-a gradient was elevated. A chest computed tomography revealed multiple bilateral pulmonary nodules. Broncholaveolar lavage yielded 485 white blood cells with 10 % lymphocytes. Gram stain, acid fast stain, and Grocott’s methenamine silver stain were negative. Bacterial, mycobacterial, fungal and viral cultures were negative as well. An open lung biopsy was obtained. Pathology revealed marked widening of alveolar septa by lymphocytic infiltrates consistent with the diagnosis of LIP. Stains and cultures did not yield any infectious pathogen

DISCUSSION: A case series of HIV infected adults with tissue diagnosis of LIP had a median viral load of 92000 copies/mL at the time of diagnosis. Patients with elevated viral loads are more likely to have lymphocytes, mainly CD8 cells, recruited to the lungs leading to histological changes of LIP. Given that our patient had undetectable plasma viral loads suggests that mechanisms other than HIV viral replication can be implicated in the etiology of LIP. In HIV infected persons, one possible hypothesis is the reactivation of viruses like Epstein Barr Virus (EBV) or human T-lymphotropic virus type I (HTLV-1) that leads to a lymphoproliferative response. Furthermore, autoimmune dysregulation might play a role in the pathogenesis of LIP. Dysgammaglobulinemia and autoimmune diseases like Sjogrens, systemic lupus erythematosus and rheumatoid arthritis have been cited in literature as coexisting with LIP [3]. Our patient’s autoimmune work up was unrevealing

CONCLUSIONS: Although commonly described as a complication of HIV in infected children, LIP remains a rare entity in adults. To our knowledge, we presented the first case of LIP in an HIV infected adult with an undetectable viral load

Reference #1: Swigris JJ et al. Lymphoid interstitial pneumonia: a narrative review. Chest 2002; 122:2150-64

Reference #2: Van Zyl-Smit RN et al. HIV associated lymphocytic interstitial pneumonia: a clinical, histological and radiographic study from an HIV endemic resource - poor setting. BMC Pulm Med 2015; 15:38

Reference #3: Dufour V et al. Improvement of symptomatic human immunodeficiency virus-related lymphoid interstitial pneumonia in patients receiving highly active antiretroviral therapy. Clin Infect Dis 2003; 36:e127-30

DISCLOSURE: The following authors have nothing to disclose: Sara Assaf, David Stoeckel

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