Lymphocytic Interstitial Pneumonitis Research Articles

Respiratory morbidity from lymphocytic interstitial pneumonitis (LIP) in vertically acquired HIV infection

The aim of the study was to define the respiratory morbidity caused by lymphocytic interstitial pneumonitis (LIP) in children with vertically acquired HIV infection. A retrospective case note review was...

Is Lymphocytic Interstitial Pneumonitis an Early Stage of MALT Lymphoma in HIV-Infected Pediatric Patients?

Is Lymphocytic Interstitial Pneumonitis an Early Stage of MALT Lymphoma in HIV-Infected Pediatric Patients?

LYMPHOCYTIC INTERSTITIAL PNEUMONITIS AND NONSPECIFIC INTERSTITIAL PNEUMONITIS

Nonspecific interstitial pneumonitis (NIP) and lymphocytic interstitial pneumonitis (LIP), with or without lymphocytic alveolitis, are poorly understood pulmonary complications of HIV infection. These disorders probably represent a spectrum of lymphoproliferative processes that overlap, rather than distinct illnesses. The clinical presentation, radiographic findings, and physiologic abnormalities in NIP and LIP are not specific and therefore require a biopsy for definitive diagnosis. The clinical course of these illnesses is generally favorable, even without specific treatment.

Thoracic disease in children with AIDS.

Knowledge of common and uncommon thoracic pathologic conditions in children with acquired immunodeficiency syndrome (AIDS) can expedite disease management. Chest radiography, computed tomography (CT), and magnetic resonance (MR) imaging are useful in cases involving possible complications of thoracic AIDS. Lymphocytic interstitial pneumonitis (LIP) is generally seen on plain radiographs and CT scans as a diffuse, symmetric, reticulonodular or nodular pattern, occasionally associated with mediastinal or hilar adenopathy. Chronic consolidations and bronchiectasis may be observed in pediatric AIDS patients with no evidence of previous LIP. Bacterial pneumonia, a frequent initial manifestation of AIDS, appears as lobar or segmental consolidations on radiographs. Radiographic findings of Pneumocystis carinii pneumonia, the most common infection, include rapidly progressive increased air-space opacity with air bronchograms. Lymphoma often appears as a mediastinal or hilar mass, often without involvement of the lung parenchyma. Thoracic smooth muscle tumors have also been observed in children with AIDS. Multilocular thymic cysts have low attenuation on CT scans and increased signal intensity on T2-weighted MR images. Most pediatric AIDS patients with cardiac disease have cardiomegaly, often associated with pulmonary edema, at chest radiography. An esophagogram may show ulceration, plaque formation, mucosal edema, and dysmotility in patients with candidal esophagitis.

Pulmonary involvement in primary Sjögren's syndrome.

Interstitial pulmonary fibrosis and tracheobronchial sicca are the most common presentation of pulmonary involvement in primary Sjögren's syndrome. There is wide spectrum of less common manifestations, including pulmonary arterial hypertension, pseudolymphoma, pulmonary lymphoma, lymphocytic interstitial pneumonitis, amyloidosis, and pleurisy. Pulmonary function test abnormalities showing a restrictive pattern and cellular abnormalities in bronchoalveolar lavage fluid for prevalent in patients without respiratory complaints and normal chest radiographs. Long-term prospective controlled studies are needed to determine the clinical course and significance of these findings.

Disease in children infected with HIV in Abidjan, Cote d'Ivoire

To document the range of disease in African children infected with HIV. Necropsy results in consecutive children aged 1 month or more who were HIV positive and in children who were HIV negative for comparison; IgA western blots on serum samples from children under 2 years of age who were positive for HIV-1 to test the validity of routine HIV serology. Largest hospital in Abidjan, Côte d'Ivoire. 78 children who were HIV positive and 77 children who were HIV negative on whom a necropsy was performed; their median ages at death were 18 and 21 months respectively. 36 HIV positive children and 29 HIV negative children were 1-14 months old; 42 HIV positive and 48 HIV negative children were > or = 15 months old. Cause of death and prevalence of diseases confirmed pathologically. Respiratory tract infections were more common in HIV positive than in HIV negative children (73 (94%) v 52 (68%); P < 0.05), and were aetiologically heterogeneous. Pneumocystis carinii pneumonia was found in 11 out of 36 (31%) HIV positive children aged < 15 months, but in no HIV negative children. Among older children measles was more common in HIV positive children (8/42 (19%) v 2/48 (4%); P < 0.06). Pyogenic meningitis was present in similar proportions of HIV positive and HIV negative children aged < 15 months (7/36 (19%) and 7/29 (24%)). In HIV positive children tuberculosis (1/78), lymphocytic interstitial pneumonitis (1/78), and HIV encephalitis (2/78) were rare. There is greater overlap between diseases associated with HIV infection and other common health problems in African children than there is in adults. Compared with adults, HIV positive children had a high prevalence of P carinii pneumonia and a low prevalence of tuberculosis. Measles, but not malaria, was associated with HIV infection.

Role of tissue diagnosis in pulmonary involvement in pediatric human immunodeficiency virus infection.

Pulmonary complications occur commonly during HIV infection. The aim of this study was to evaluate the clinical value of lung tissue examination in the diagnosis and treatment of pulmonary disorders in children with HIV infection. The medical records of 347 children enrolled between January, 1990, and April, 1994, into various antiretroviral therapy protocols were reviewed to identify patients who underwent a lung biopsy. Fourteen patients underwent diagnostic lung biopsies on 16 separate occasions. The most common radiologic findings were nodular infiltrates which were localized in 7 patients and diffuse in 6. Eight patients presented with fever and progressive respiratory distress unresponsive to empiric therapy, whereas the rest had progressive nodular infiltrates. The pathologic diagnoses included opportunistic infection in 7 patients, lymphocytic interstitial pneumonitis in 5, non-Hodgkin's lymphoma in 3 and interstitial fibrosis in 1. The biopsy led to a major change in the treatment of 7 patients which resulted in a significant improvement of the pulmonary process in all of them. In an additional patient the excisional biopsy proved curative. When patients are selected appropriately, lung biopsy might have a significant impact on therapy and outcome in HIV-infected children with pulmonary infiltrates.

Clinical significance of resolution of chest X-ray findings in HIV-infected children with lymphocytic interstitial pneumonitis (LIP)

Lymphocytic interstitial pneumonitis (LIP) in HIV-infected children is generally associated with better prognosis as compared with children with Pneumocystis carinii pneumonia (PCP). We prospectively studied 12 cases of HIV-infected children with LIP over a 4-year period in an effort to document one aspect of the natural history of this clinical entity. Severe CD4 lymphocytopenia was associated with complete resolution of the chest X-ray findings in five patients, one of whom died of disseminated Mycobacterium avium complex. A second patient developed rapid-onset subacute HIV encephalopathy at the time when the CD4-lymphocyte count declined from 589 to 39, and the lung findings resolved spontaneously. The resolution of the lung pathology may be the first indication of severe immune suppression and a warning of the increased risk for opportunistic infections. Therefore, in those settings where diagnostic laboratory facilities are not easily available, the resolution of the reticulonodular changes on chest radiographs is a poor prognostic sign in HIV-infected children with LIP.

Interstitial pneumonitis in patients infected with the human immunodeficiency virus.

A study was performed to identify the clinical, radiographic, and histopathological features of interstitial pneumonitis in patients infected with the human immunodeficiency virus. A retrospective review was made of the case notes, chest radiographs, and histopathological results of seven HIV-1 antibody positive patients with symptomatic diffuse pulmonary disease and a pathological diagnosis of non-specific interstitial pneumonitis. All patients had dyspnoea, with or without cough, and chest radiographs showing diffuse infiltrates. The arterial oxygen tension ranged widely from 5.9 to 13.1 kPa. The initial clinical diagnosis was Pneumocystis carinii pneumonia in most cases. The pathological diagnosis was made by transbronchial biopsy in one case and by open lung biopsy in six cases. The interstitial pneumonitis consisted of a patchy lymphocytic infiltrate composed of B cells in focal aggregates and T cells in a more diffuse distribution. The T cell population was a mixture of CD4+ and CD8+ cells. The histological findings contrast with the more extensive infiltrate of predominantly CD8+ lymphocytes seen in HIV-associated lymphocytic interstitial pneumonitis which occurs mainly in children. The condition ran a subacute course. Three patients spontaneously improved and three improved with steroid therapy. Long term survival was less than three years, the prognosis being determined by other infective or neoplastic complications. Non-specific interstitial pneumonitis usually presents with an illness resembling Pneumocystis carinii pneumonia but occurs when the CD4 and total lymphocyte counts are still preserved. The pneumonitis resolves spontaneously or responds to steroids, and does not itself lead directly to the patient's death. It does, however, appear to mark a downturn in the course of HIV infection.

Unusual lymphoproliferative disorders in nine adults with HIV or AIDS: CT and pathologic findings.

To identify characteristic computed tomographic (CT) findings in unusual pulmonary lymphoproliferative disorders seen in adults with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The authors retrospectively reviewed the CT scans and pathologic specimens from nine patients with pulmonary lymphoproliferative disorders. CT scans were evaluated for nodules, reticulation, areas of ground-glass attenuation, consolidation, and bronchial disease. Changes seen in pathologic specimens were classified as consistent with classic lymphocytic interstitial pneumonitis (LIP), mucosa-associated lymphoid tissue lymphoma (MALTOMA), or atypical lymphoproliferative disorder (ALD). Immunopathologic results were reviewed when available. Eight patients had AIDS. Five patients had classic LIP. One patient had MALTOMA, and three patients had ALD. Altogether, 2-4-mm-diameter nodules were the predominant CT finding in eight patients; these were peribronchovascular in four patients. The presence of interstitial nodules correlated with the pathologic finding of nodular disease in seven patients. Familiarity with these AIDS-related disorders and their CT appearance should assist in the differential diagnosis.

Nonspecific and Lymphocytic Interstitial Pneumonitis in HIV-Infected Individuals

Nonspecific and Lymphocytic Interstitial Pneumonitis in HIV-Infected Individuals

Lymphocytic interstitial pneumonitis in a patient with systemic lupus erythematosus

A 34-year-old woman with stable systemic lupus erythematosus (SLE) treated with low-dose prednisone and hydroxychloroquine developed multiple bilateral pulmonary nodules. Open lung biopsy documented lymphocytic interstitial pneumonitis (LIP). LIP should be considered in the differential diagnosis of nodular pulmonary lesions in patients with SLE.

An AIDS-like condition induced in baboons by HIV-2.

Six baboons (Papio cynocephalus) were intravenously inoculated with the human immunodeficiency virus-type 2 (HIV-2) strain HIV-2UC2. All seroconverted within 6 weeks after inoculation; five animals became persistently infected. Four developed lymphadenopathy, and three of the animals had CD4+ T cell loss within 18 to 24 months after inoculation. One of these baboons, showing severe clinical symptoms, showed at necropsy widespread dissemination of virus with follicular depletion in the lymph nodes, extensive fibromatosis involving lymphoid and nonlymphoid tissues, and lymphocytic interstitial pneumonitis. Another animal is cachectic and exhibited lymphoid follicular lysis and fibrous skin lesions. Other baboons inoculated with a second strain, HIV-2UC14, have shown evidence of persistent infection. HIV-2 infection of baboons provides a valuable animal model for studying HIV persistence and pathogenesis and for evaluating approaches to antiviral therapies.

280 HYDROXYCHLOROQUINE IN THE TREATMENT OF CHRONIC

We report on our experience in 8 patients with different forms of chronic interstitial lung disease. These included lymphocytic interstitial pneumonitis and chronic bronchiolitis. Clinical presentation consisted in tachypnoea, cyanosis, cough, crepitant rales and failure to thrive. Diagnostic work up included lung function studies in all patients, bronchoscopy with bronchoalveolar lavage (BAL) in 7 patients and open lung biopsy in 4 patients. Therapy included oral and inhaled steroids, inhalation with bronchodilators and oral hydroxychloroquine. While most of the patients did not respond to steroids alone, hydroxychloroquine improved the clinical and laboratory findings in a majority of our patients. Conclusion: Further controlled studies are required for propper evaluation of the effect of hydroxychloroquine in the treatment of chronic interstitial lung disease in children.

Lymphocytic Interstitial Pneumonitis Following Legionnaire's Pneumonia

We were most interested in the case report of Dicicco and Anderson, which further substantiates our observation that acute L pneumophila pneumonia may cause long-lasting pneumonitis. Furthermore, there seem to be striking similarities between these cases and well-known pathoanatomic entities of idiopathic interstitial pneumonitis. In our opinion, prospective studies should focus on the follow-up of patients with acute Legionella pneumonia to define the incidence, natural course, and benefit from corticosteroid treatment of the chronic alveolitis. In addition, antibodies to L pneumophila should be determined in cases of interstitial pneumonitis of unknown origin. Lymphocytic Interstitial Pneumonitis Following Legionnaire's PneumoniaCHESTVol. 105Issue 1PreviewThe two cases described by Hürter et al1 in the January 1992 issue of Chest are of particular interest in that infiltrating lymphocytes and plasma cells were present. This suggests a diagnosis of lymphocytic interstitial pneumonitis (LIP), a form of chronic interstitial lung disease. We would like to report a similar case that we recently encountered. Full-Text PDF

Localized Inflammatory Pulmonary Disease in Subjects Occupationally Exposed to Asbestos

In reviewing pathology materials from patients occupationally exposed to asbestos, we identified eight patients with either localized nodules in their lung or unusual pathologic changes. The chest radiographs of six patients showed isolated parenchymal nodules thought to represent primary neoplasms. In three cases, pathologic examination of these nodules showed intraluminal fibrosis and inflammation of the distal airways, a pattern of change frequently referred to as "bronchiolitis obliterans organizing pneumonitis." In each instance, asbestos bodies were present in association with the fibroinflammatory tissue. In one case, the nodule showed a desquamative interstitial pneumonitis type pattern, and asbestos bodies were present admixed with the alveolar macrophages and occasionally within their cytoplasm. In one case, the nodule was composed of nonspecific inflammation and fibrosis with focal bronchiolitis obliterans and frequent asbestos bodies scattered throughout the area of inflammation and fibrosis, and in another case, necrotizing inflammation association with Aspergillus fungal organisms was identified. Granulomatous inflammation was the dominant pulmonary pathologic change in one patient, and the other patient's lung biopsy specimen showed a diffuse lymphocyte-plasma cell interstitial pneumonitis. The cases reported suggest that asbestos may cause localized lesions in the lung that clinically and radiographically are misinterpreted as cancer and that pathologically show inflammation and fibrosis of the distal airways. In addition, our observations suggest that asbestos may cause granulomatous inflammation, a desquamative interstitial type pneumonitis, and a lymphocytic interstitial pneumonitis type pattern. Our conclusions that asbestos may cause these pathologic changes are supported by case reports in the clinical and pathologic literature, clinicopathologic studies, and by experimental studies.

Lung deposition of nebulised pentamidine in children.

Nebulised pentamidine is effective for preventing Pneumocystis carinii pneumonia in adults with acquired immunodeficiency syndrome. The nebuliser dose required to produce equivalent lung concentrations of pentamidine in children is unknown. This study was performed to measure pulmonary pentamidine deposition in children and to relate this to age, ventilation pattern, and body size. Nebulised pentamidine (50 mg in 6 ml saline) was administered to 12 children (including one with lymphocytic interstitial pneumonitis) and to six adults with human immunodeficiency virus infection using a Respirgard II nebuliser. Technetium-99m labeled colloidal human serum albumin was used as an indirect marker for pentamidine and deposition in the lungs was detected by a gamma camera. Absolute deposition of pentamidine was not related to age, height, weight, spirometry, or ventilation characteristics. Deposition, as a mean (SD) percentage of nebuliser output, was similar in children aged 8-11 years (5.5(2.4)%), teenagers aged 12-15 years (7.2(2.2)%) and adults (7.1(2.6)%). Aerosol concentration within the lungs (% nebuliser output deposited/predicted total lung capacity) was therefore higher in children (1.9(1.5)%/1) and teenagers (1.9(0.7)%/1) than in adults (1.0(0.7%)/1), and was negatively correlated with height (r = -0.69) and weight (r = -0.50). Deposition of aerosol in the region of the large central airways was particularly marked in children. Small reductions in forced expiratory volume in one second and forced vital capacity after treatment did not differ significantly between adults and children and visual analogue scores of subjective adverse effects did not vary with age. These results suggest that children probably require lower nebuliser pentamidine doses to produce lung pentamidine concentrations equivalent to those found to be effective for preventing P carinii pneumonia in adults using the Respirgard II nebuliser.

AIDS associated bronchiectasis: CT features.

The occurrence of bronchiectasis has only rarely been noted among the protean manifestations of HIV infection in the lungs. We retrospectively identified bronchiectasis on CT scans in 12 HIV + and/or AIDS patients in the absence of either documented mycobacterial infection or a history of prior recurrent pyogenic infection. Pneumonitis was documented in 10 of 12 cases. In eight cases, bronchiectasis was associated with episodes of pyogenic infection; four of these patients also had documented opportunistic infections, including three cases of Pneumocystis carinii pneumonia (PCP). Two patients had infection due solely to PCP. In two cases, bronchiectasis was found in association with one case each of lymphocytic interstitial pneumonitis and nonspecific interstitial pneumonitis, respectively. Although the true incidence of bronchiectasis in this population remains to be established, in our experience bronchiectasis should be considered among the varied pulmonary manifestations of HIV infection. Furthermore, the seemingly rapid development and extent of bronchiectasis in this population suggest an accelerated form of the disease.

PULMONARY AND GASTROINTESTINAL MANIFESTATIONS OF SJÖGREN’S SYNDROME

The respiratory system is frequently involved in primary SS but this involvement is rarely clinically significant. Its manifestations are secondary to desiccation of the tracheobronchial tree and lymphocytic infiltration of the lung parenchyma. The desiccation of the tracheobronchial tree gives rise to the most important clinical manifestation, dry cough (xerotrachea), but is rarely a cause of infection and obstructive airways disease. The lymphocytic infiltration of the lung parenchyma starts as lymphocytic alveolitis in a very large number of SS patients but rarely evolves into frank lymphocytic interstitial pneumonitis and fibrosis. Even more rare is the evolution of pseudolymphoma into malignant lymphoma. Pleurisy with or without effusion is not a frequent manifestation of primary SS. It occurs often in secondary SS and is due to the underlying rheumatic disorder. In general, secondary SS rarely has significant pulmonary manifestations other than those of the disorder it accompanies. The manifestations from the gastrointestinal system in patients with SS include mucosal dryness, accelerated dental decay, and enlargement of the major salivary glands, as well as dysphagia, nausea, epigastric pain, and dyspepsia. The dysphagia is probably secondary to esophageal dysfunction, and the gastric symptoms might be attributable to chronic atrophic gastritis. Whether the small bowel is affected in SS patients is not clear. Pancreatic involvement usually is being expressed as subclinical acute or chronic pancreatitis. Finally, the liver could be involved in SS patients, and some studies indicate that the pathogenic process responsible for the hepatic damage and for the salivary gland destruction could be similar.

Lymphoid pneumonitis in 50 adult patients infected with the human immunodeficiency virus: Lymphocytic interstitial pneumonitis versus nonspecific interstitial pneumonitis

Lymphocytic interstitial pneumonitis (LIP) and nonspecific interstitial pneumonitis (NIP) are pulmonary complications of human immunodeficiency virus (HIV) infection that occur in the absence of a detectable opportunistic infection or neoplasm. We reviewed lung biopsy specimens from 50 adult HIV-infected patients, of whom four had LIP and 46 had NIP. The majority (47 of 50) of specimens from patients with NIP showed mild chronic interstitial pneumonitis ( CIP NIP ), with three showing features of diffuse alveolar damage, organizing phase. In contrast to CIP NIP , the five specimens from four patients with LIP demonstrated more extensive lymphocytic interstitial infiltrates that extended into the alveolar septal interstitium. The majority of the interstitial lymphocytes in both NIP and LIP were of T-cell origin and stained for UCHL-1. The etiologies of NIP and LIP remain unknown. Since the common opportunistic infections were excluded by routine methods, we sought, with special techniques, to investigate whether HIV, Epstein-Barr virus (EBV), or cytomegalovirus (CMV) could be identified in lung biopsy specimens from these patients. By in situ hybridization, we found one LIP specimen with expression of large amounts of HIV RNA primarily within macrophages in germinal centers; in the remaining specimens, occasional cells expressing HIV RNA were found (two LIP and four NIP). Neither CMV nor EBV was found by in situ hybridization in seven specimens; in these same specimens EBV was detected using the polymerase chain reaction in only one case of NIP, similar to results in control specimens. These results, together with the knowledge that lymphocytic pulmonary lesions may be caused by lentiviruses in humans and animals, suggest that HIV plays a significant role in the pathogenesis of both NIP and LIP in adult HIV-infected patients; in contrast, our data do not demonstrate a direct role for either EBV or CMV.