Tuberc Respir Dis.  2006 Sep;61(3):289-293. 10.4046/trd.2006.61.3.289.

A Case of Diffuse Infiltrative Lymphocytosis Syndrome Associated with Human Immunodeficiency Virus Infection

• Kwon SO
• Park WW
• Lee HK
• Lee SS
• Kang YK
• Lee YM
• Lee HP
• Kim JI
• Choi SJ
• Yum HK

• KMID: 1970270
• DOI: http://doi.org/10.4046/trd.2006.61.3.289

Abstract

Diffuse infiltrative lymphocytosis syndrome is an autoimmune syndrome that is characterized by the oligoclonal expansion of CD8+ T-lymphocytes in response to human immunodeficiency virus (HIV) antigens. The clinical manifestations include bilateral enlargement of the parotid glands, lymphocytic interstitial pneumonitis, lymphocytic hepatitis, neurological involvement and systemic lymphadenopathies. In addition to a positive HIV test, the diagnostic histopathological findings are CD8+ T-lymphocytic infiltrations in the lymphnodes, liver, lung, muscle and the salivary or lacrimal glands without granulomatous or neoplastic involvement. We report a case of pulmonary involvement of diffuse infiltrative lymphocytosis syndrome that was associated with a human immunodeficiency virus infection.

Keyword

Diffuse infiltrative lymphocytosis syndrome; HIV; CD8+

MeSH Terms

Hepatitis
HIV*
Humans*
Lacrimal Apparatus
Liver
Lung
Lung Diseases, Interstitial
Lymphocytosis*
Parotid Gland
T-Lymphocytes

Figure

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  Figure 1 Chest X-ray. Diffuse bilateral mixed fine reticular and poorly-defined micronodular opacities are distributed at both lung fields.

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  Figure 2 High Resolution Computed Tomography of lung on admission. Mixed fine and poorly defined micronodules are scattered at both lung fields. Centrilobobular micronodules are distributed in both lung fields.

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  Figure 3 Excisional biopsy of mucosal polyp at lower lip (H&E staining, ×400). Acanthosis, parakeratosis, and intracellular edema associated with characteristic nuclear inclusions are consistent with hairy leukoplakia of HIV-infected individual.

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  Figure 4 Open surgical lung biopsy (H&E staining, ×40). Diffuse and nodular infiltrations of interstitial lymphoplasma cells are revealed in peri-bronchiolar and peri-vascular spaces.

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  Figure 5 Open surgical lung biopsy (H&E staining, ×200). Multifocal epithelioid histiocytes, multinucleated giant cells and poorly-formed sarcoid-like granulomas are aggregated in interstitium.

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  Figure 6 Immunohistochemical stain of open lung biopsy. (A) CD4+ T-lymphocytes are abscent, and (B) CD8+ T-lymphocytes are markedly predominant.

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