Lymphoid Interstitial Pneumonitis and Infection with Human Immunodeficiency Virus Type 2

Abstract

Lymphoid interstitial pneumonitis (LIP) was frequently seen in children with acquired immunodeficiency syndrome (AIDS) infected by human immunodeficiency virus type 1 (HIV-1).1Pahwa S Kaplan M Fikrig S Pahwa R Sarngadharan MG Popovic M et al.Spectrum of human T-cell lymphotropic virus type III infection in children.JAMA. 1986; 255: 2299-2305Crossref PubMed Scopus (139) Google Scholar Cases of LIP have also been reported in HIV-1 infected adult patients.2Solal-Celigny P Couderc LJ Herman D Herve P Schaffar-Deshayes L Brun-Vezinet F et al.Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome related complex.Am Rev Respir Dis. 1985; 131: 956-960PubMed Google Scholar Human immunodeficiency virus type 2 (HIV-2) was identified in 1986 and has been associated with AIDS.3Clavel F Guetard D Brun-Vezinet F Chamaret S Rey MA Santos-Ferreira Mo et al.Isolation of a new human retrovirus from West African patients with AIDS.Science. 1986; 233: 343-346Crossref PubMed Scopus (870) Google Scholar, 4Brun-Vezinet F Rey MA Katlama C Girard PM Roulot D Yeni P et al.Lymphadenopathy associated virus type 2 in AIDS and AIDS-related complex.Lancet. 1987; 1: 128-132Abstract PubMed Scopus (122) Google Scholar To our knowledge, LIP associated with HIV-2 infection has not yet been described. We report such a case. A 55-year-old French homosexual man presented in February 1984 with cryptococcal meningitis. In April 1985, chest x-ray film showed a bilateral reticular pattern without mediastinal lymph-node enlargement. Open lung biopsy was performed and a diagnosis of LIP was established. Specific staining for pathogens was negative. On immunologic testing, he had negative tuberculin skin tests and low absolute numbers of CD4+ lymphocytes (50/mm3) and a CD4 + /CD8+ ratio of 0.18. From April 1985 to June 1986 he was chronically ill with intermittent diarrhea and weight loss. He died in July 1986. Autopsy findings showed a high-grade non-Hodgkins lymphoma made up of diffuse, large cells with involvement of the lungs, liver, spleen, and myocardium. Serum samples taken and stored in 1985 were tested for the presence of HIV-1 and HIV-2 antibodies using an enzyme-linked immunosorbent assay and Western blot analysis (Diagnostics Pasteur).3Clavel F Guetard D Brun-Vezinet F Chamaret S Rey MA Santos-Ferreira Mo et al.Isolation of a new human retrovirus from West African patients with AIDS.Science. 1986; 233: 343-346Crossref PubMed Scopus (870) Google Scholar, 4Brun-Vezinet F Rey MA Katlama C Girard PM Roulot D Yeni P et al.Lymphadenopathy associated virus type 2 in AIDS and AIDS-related complex.Lancet. 1987; 1: 128-132Abstract PubMed Scopus (122) Google Scholar No antibodies to HIV-1 were detected, but HIV-2 infection was diagnosed by the presence of antibodies to HIV-2 envelope glycoproteins gp 41 and gp 130-105. Serologic test for human T-cell leukemia virus type 1 was negative. Our patient was probably infected with HIV-2 by multiple homosexual contacts while travelling in West Africa (Guinea-Bissau). In this case, LIP showed some features distinctive from previously-reported cases of LIP in adults with HIV-1 infection. First, the occurrence of LIP in a white man contrasts sharply with the usual occurrence of LIP in black HIV-1 infected patients originating from Central Africa.2Solal-Celigny P Couderc LJ Herman D Herve P Schaffar-Deshayes L Brun-Vezinet F et al.Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome related complex.Am Rev Respir Dis. 1985; 131: 956-960PubMed Google Scholar, 5Itescu S Brancato LJ Buxbaum J Gregersen PK Rizk CC Croxson TS et al.A diffuse infiltrative CD8 lymphocytosis syndrome in human immunodeficiency virus (HIV) infection: a host immune response associated with HLA-DR5.Ann Intern Med. 1990; 112: 3-10Crossref PubMed Scopus (248) Google Scholar Second, the patient did not show salivary gland enlargement or persistent generalized lymphadenopathy, as reported in the HIV-1 infected patient with LIP (this being the pulmonary manifestation of a more diffuse CD8+ lymphocytic visceral infiltration).2Solal-Celigny P Couderc LJ Herman D Herve P Schaffar-Deshayes L Brun-Vezinet F et al.Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome related complex.Am Rev Respir Dis. 1985; 131: 956-960PubMed Google Scholar, 5Itescu S Brancato LJ Buxbaum J Gregersen PK Rizk CC Croxson TS et al.A diffuse infiltrative CD8 lymphocytosis syndrome in human immunodeficiency virus (HIV) infection: a host immune response associated with HLA-DR5.Ann Intern Med. 1990; 112: 3-10Crossref PubMed Scopus (248) Google Scholar Infection with HIV-2 may have a direct causal role in the development of LIP, as has been suggested with HIV-1.6Chayt KJ Harper ME Marselle LM Lewin EB Rose RM Oleske JM et al.Detection of HTLV-III RNA in lungs of patients with AIDS and pulmonary involvement.JAMA. 1986; 256: 2356-2359Crossref PubMed Scopus (124) Google Scholar HIV-2 infection should be looked for in patients with LIP.