Nonspecific Interstitial Pneumonitis Mimicking Pneumocystis carinii Pneumonia

Abstract

Bronchoalveolar lavage (BAL) and transbronchial biopsies from 351 human immunodeficiency virus (HIV)-positive patients with presumed Pneumocystis pneumonia were analyzed to determine the spectrum and frequency of interstitial lung disease mimicking Pneumocystis pneumonia. Among 67 patients without Pneumocystis, nonspecific interstitial pneumonitis (NSIP) was the most common histologic diagnosis (n = 16). Tissue sections from patients with NSIP were tested by in situ hybridization for Epstein-Barr virus, cytomegalovirus (CMV), and HIV; sections were also tested with the polymerase chain reaction (PCR) for HIV env and gag protein DNA. In patients with NSIP, Epstein-Barr virus and CMV could not be detected by in situ hybridization; HIV nucleic acid was amplifiable with PCR in 10 of 15 formalin-fixed, paraffin-embedded tissue sections. Symptoms, physical findings, and blood gas values were similar in patients with NSIP and matched controls with Pneumocystis. Patients with NSIP presented earlier in the course of HIV, with higher weight, serum albumin levels, and CD4+ T-lymphocyte counts (492 +/- 828 cells/mm3 versus 57 +/- 60 cells/mm3), and more normal lactate dehydrogenase (LDH) levels (280 +/- 113 IU/L versus 432 +/- 141 IU/L; means +/- SD). Seven to 10 d later, improvement in blood gas values was of similar magnitude for the two groups. Only one other unequivocal, treatable infection was diagnosed only with transbronchial biopsy. These results indicate that NSIP may be the most common diagnosis mimicking Pneumocystis pneumonia in acquired immune deficiency syndrome (AIDS), and that NSIP may improve during empiric therapy.

Pneumonia Pneumosistis

“…Gejala berjalan progresif dan sering berakhir fatal. 16,17 Pneumonia pneumosistis merupakan salah satu tanda bahwa seorang yang terinfeksi HIV telah masuk stadium AIDS. Jumlah sel T CD4+ pada pasien ini umumnya <200/mm 3 .…”

Pulmonary Manifestations of HIV Disease

“…This disease entity may mimic PcP 251 and even appear to respond to PcP treatment 252 . However a search for Pneumocystis jirovecii is usually negative 253 .…”

Nonspecific Interstitial Pneumonitis in HIV-infected Patients

“…Sputum induction for diagnosis of PCP is associated with variable sensitivity of 50 to 95%. [2][3] . Because the test can have a negative predictive value as low as 39%, the absence of Pneumocystis carinii in induced sputum does not reliably exclude the diagnosis of PCP.…”

“…Other patients may be too ill to undergo bronchoscopy. Thus, many HIV-infected patients with pneumonitis are empirically treated without a confirmed diagnosis 3 . In some cases, however, pneumonitis cannot be ascribed either to known infectious agents or to malignancy.…”

“…These disorders are believed to be inflammatory in origin and are grouped into two entities: lymphoid interstitial pneumonitis (LIP) and nonspecific interstitial pneumonitis (NSIP) 4 . In one study on 351 HIV-positive patients with pneumonitis, NSIP was the most common histologic diagnosis in patients without PCP 3 . Because treatment and prognosis of PCP and NSIP are different, it is important to differentiate these entities.…”