Abstract
28 of 30 (93%) children with AIDS or prodrome displayed clinical and radiologic evidence of progressive interstitial pulmonary disease. Usually no adventitious sounds were heard on pulmonary auscultation. Digital clubbing occurred in 6 patients. Chronic hypoxia (PO2<80 on room air) developed in most patients. Chest roentogenograms displayed diffuse reticulonodular interstitial densities with perihilar haze. Histologically, interstitial lymphocyte and plasma cell infiltration was noted in 8 of 8 pulmonary biopsy specimens. Infiltrates were both focal-nodular and diffuse, occurring both within alveolar septae and surrounding bronchioles. Silver methenamine stain was positive for pneumocystis carinii in 3 patients, all of whom responded well to intravenous Trimethoprim-sulfamethoxasole or Pentamidine. Mycobacterium avium was isolated in 2 patients. Pulmonary cyto-megalovirus was noted in 2 patients. In 2 patients resolution of chronic hypoxia was achieved following daily and subsequently alternate day Prednisone therapy. Chronic intersitital pulmonary disease in pediatric patients with AIDS or its prodrome may be similar to lymphocytic interstitial pneumonitis and may be a manifestation of polyclonal B cell activation.
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