A 29-year-old black man with HIV in...

A 29-year-old black man with HIV infection had an abnormal chest x-ray film with bilateral hilar adenopathy. Sarcoidosis was suspected, if it were not that a thorough and comprehensive evaluation was complet to differentiate the multiple infectious and noninfectious causes of these findings. Biopsy of a hilar node and pulmonary tissue revealed sarcoidosis.

(Chest 1989; 96:201-02)

Coexistence of HIV infection and active sarcoidosis appears to be quite rare. To date, there are alone two case reports of HIV infection and sarcoidosis occurring in the same patient,[1,2] and in the two cases, sarcoidosis was diagnosed at least ten years before the HIV infection was documented. We report the findings in a patient who was set to have stage 1 sarcoidosis during the evaluation of HIV infection.

Case Report

The patient is a 29-year-old black man who at the age of 26 years had had a normal chest x-ray film as part of a physical examination for enlistment in the armed forces. couple years later, during routine screening required by way of the Department of Defense, he was base to be positive for HIV antibody on ELISA and Western blot. During initial HIV evaluation, he denied all known risk factors for HIV infection. There was no occupational frontage to beryllium or other agents known to cause a granulomatous proces The patient was asymptomatic. The findings from physical examination were unremarkable save for generalized adenopathy. A chest x-ray film revealed bilateral hilar adenopathy (Fig 1) The PPD skin example was negative. Laboratory data included a WBC of 5000/cu mm T-cell subset determined by way of flow cytometry revealed a total T-lymphocyte enclosed space count of 1,569/cu mm; the T-4 confined apartment count was 666/cu mm; the T-8 lonely dwelling count was 883/cu mm, and the T4/T8 ratio was 075 The patient was classified from the CDC classification system[3] as HIV infection arrange 3.

At the required reevaluation single year later, the patient remained asymptomatic, and the generalized adenopathy was unchanged. A chest x-ray film again showed bilateral hilar adenopathy unchanged from the previous year's consideration The PPD test remained negative. Laboratory data showed the WBC to be 5300/cu mm with a total T-cell estimate of 1,376/cu mm. The T-4 enclosed space count was 384/cu mm, the T-8 enclosed space count was 928/cu mm, and the T4/T8 ratio was 041

A gallium scan revealed uptake in the hilar regions bilaterally. At thoracotomy, the right hilar nodes and the right lung were biopsied. Histopathologic studies revealed noncaseating granulomas in the node and pulmonary samples (Fig 2) Special stains failed to reveal fungi, acid-fast bacilli, or viral inclusion bodies. improvements for fungi and mycobacteria showed no development after eight weeks. Sarcoidosis was diagnosed in succession the basis of the histopathologic findings and the lack of evidence of other infectious, inflammatory, or neoplastic conditions.

Discussion

Serologic testing for HIV antibodies has been available since 1984 Flint et al[4] exampleed 17 patients with sarcoidosis for HIV antibody using the two ELISA and Western blot techniques. These investigators[4] construct all 17 to be negative, eliminating the regard over possible false-positive results. Of the sum of two units previously reported cases of attendant HIV infection and sarcoidosis, single patient had serologic testing for HIV antibodies performed. That patient was positive by dint of both the ELISA and Western dishonor methods.[1] The other patient died in 1980 before testing was available.[2] Our case report confirms that a patient with sarcoidosis can be accurately trialed for HIV infection by the ELISA and Western disgrace tests.

Sarcoidosis has been reported in a variety of immunodepressed states, including lung cancer and malignant lymphoma,[5] and in association with cytotoxic chemotherapy for several different malignant neoplasms.[6-8] Israel[9] has allude toed that the immunosuppressed state may predispose patients to the exhibition of sarcoidosis. At this time, we are unable to postulate a relationship between the HIV infection and sarcoidosis in this patient. Indeed, if there were a authentic relationship between these two entities, we would have anticipateed more published case reports connecting sarcoidosis with HIV infection. The at hand case may just represent pair independent conditions in the same patient.

We recognize that of equal authority HIV infection and sarcoidosis may be rare, unless the diagnosis must be considered when evaluating patients with HIV infection and hilar adenopathy. Hodgkin's disease, lymphoma, tuberculosis, atypical mycobacterial infections, and fungal infections are other recognized conditions that must be rul out

References

[1] Wurm K Ewert G Lohr G Sarcoidosis complicated on HTLV III-infection: steroid therapy in combination with thymostimulin. Sarcoidosis 1987; 4:68-70

[2] Kalter s Lopez-Berestein G. Acquired immune deficiency syndrome in a patient with prior sarcoidosis: case report with monocyte function studies. Tex M 1985; 9:44-6

[3] CDC Classification classification for human T-lymphotropic virus impressed sign III/lymphadenopathy-associated virus infections. Morbidity Mortality Weekly Rep 1986; 35:334-39