Abstract
Diffuse infiltrative lymphocytosis syndrome (DILS) in human immunodeficiency virus (HIV) infection presented most commonly with parotidomegaly and sicca symptoms in the pre-antiretroviral era. However, numerous clinical manifestations are possible due to the multi-organ nature of the CD8+ lymphocytic infiltration. Renal involvement is infrequently described, but common characteristics of a renal syndrome associated with DILS have been identified. This case series describes four South African HIV-positive patients with DILS, in whom renal failure was the sole clinical manifestation. As DILS responds well to antiretroviral and corticosteroid therapy, this series highlights the importance of considering this syndrome as a cause of renal failure in an HIV-positive patient.
Highlights
In 1987, the first case of extensive multi-system CD8+ infiltration was described in an human immunodeficiency virus (HIV)-positive male [1]
We describe four South African patients with clinical and histopathological features of a diffuse infiltrative lymphocytosis syndrome (DILS)-related nephropathy
Most cases of biopsy-proven interstitial nephritis in HIV are due to drugs [12] or TB, which produces a granulomatous interstitial nephritis [13]
Summary
In 1987, the first case of extensive multi-system CD8+ infiltration was described in an HIV-positive male [1]. None of these patients presented with the classical features of parotidomegaly or sicca symptoms but rather were found to have a CD8+ lymphocytic interstitial infiltrate on renal biopsy. Case 1 A 36-year-old HIV-positive, ART-naïve male with a CD4 count of 912 cells/mm3 presented with clinical features of pulmonary tuberculosis (TB), subsequently confirmed on sputum GeneXpert.
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