Simultaneous diagnosis of cryptogenic organizing pneumonia and HIV in a 45 year old man

Abstract

SummaryBackground:Cryptogenic organizing pneumonia (COP) is a small airways disease characterized by intraluminal polyps of myxoid connective tissue which follows a subclinical course and is associated with infectious as well as non infectious processes The concomitant occurrence of human immunodeficiency virus (HIV) infection and COP has rarely been reported. We describe a unique case in which COP was a presenting feature in a patient with newly diagnosed HIV Infection.Case Report:A 45 year-old man with chronic active smoking presented to the ER with 15 months history of cough productive of minimal whitish sputum without frank or streaks of blood, low grade fever, anorexia and 4–6 lbs weight loss in past 6 months. He had three life time sexual partners. PPD status were unknown. He was extensively worked up as the Chest X ray showed cystic lesions all of which came back normal. Patient also received HIV test which was positive with CD 4 count of 546. He received bronchoscopy which revealed cryptogenic organising pneumonia. He was placed on steroids tapering course which helped in relieving the symptoms.Conclusions:HIV infection with CD 4 count above 500 has seldom been reported having COP with this case being the second in literature but this entity should be kept in mind during management of these patients.

Case of organising pneumonia in HIV infection

“…The duration of OP varied from several days to several months from onset to diagnosis 20. Three cases6–8 are the only previously reported cases in which OP and HIV infection were diagnosed concurrently and, in two of the three cases, the patients had chronic HIV infections 6 8. The other case7 was under the treatment of tuberculosis for 4 months before HIV/AIDS was detected.…”

“…OP was suspected since his chest CT exhibited migrant shadows, lung biopsy (and BAL) showed lymphocyte-dominant inflammatory cells infiltrated in interstitial tissue, and organising changes in airspaces, and his pulmonary lesions were remitted spontaneously 5 19. Little is known about OP with HIV infection, and most reported cases have occurred in individuals with low CD4 counts or AIDS 6–15. The duration of OP varied from several days to several months from onset to diagnosis 20.…”

“…Organising pneumonia (OP), which is classified as interstitial pneumonia, has various aetiologies from cryptogenic to secondary bacterial infections, certain drugs and collagen-related diseases 5. Few reports on OP with concurrent HIV or AIDS have been published 6–15…”