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We reviewed the clinical records and chest radiographs of all patients admitted to our institution between 1982 and 1984 who had pulmonary disease and who were later proved to have acquired immunodeficiency syndrome (AIDS) (95 patients). Diffuse parenchymal lung disease was the most common finding. These infiltrates were usually interstitial and caused by Pneumocystis carinii pneumonia or P. carinii combined with cytomegalovirus infection. Focal, multilobar, interstitial infiltrates were also often seen and usually caused by P. carinii or P. carinii and cytomegalovirus infections. Rarely, well-defined, multiple, interstitial nodules less than 10 mm in diameter were the only or predominant characteristic and were seen only in association with Mycobacterium tuberculosis or Cryptococcus neoformans infections or Kaposi sarcoma. Hilar or mediastinal adenopathy occurred in 17 of the 21 patients with M. tuberculosis or C. neoformans infections. In contrast, only 4% of patients with P. carinii infections presented with these findings. We also found that hilar or mediastinal adenopathy was not significantly associated with peripheral adenopathy. Lung cavitation, pleural effusion, or a normal chest radiograph was uncommon.

SUMMARY During a one month period liver biopsy was carried out on eight patients with established acquired immune deficiency syndrome (AIDS) and two suspected of having AIDS to evaluate raised liver enzymes or unexplained fever and weight loss. Each of the 10 patients were found to have hepatic granulomas. Appropriate staining techniques showed acid-fast bacilli in seven of the liver specimens. One specimen contained numerous Cryptococcal organisms. Two biopsies showed granulomas but no organisms. Liver biopsy was found to be a high yield and rapid diagnostic procedure in patients with AIDS. Our results suggest that hepatic mycobacterial infection may be more common in the syndrome than previously recognised and that liver biopsy specimens should be examined routinely for the presence of acid-fast bacilli.

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