Case 5 -
Sarcoidosis in Association with HAART Therapy in an HIV-Infected Patient
Royal Brompton Hospital and Imperial College School of Medicine
Virtual Slides as well as Still Images are displayed below.
For the fastest viewing of virtual slides, click:
under each thumbnail image below. You must have Aperio ImageScope installed on your PC.
Or, click on slide thumbnail images to view each slide
If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP Virtual Slides. Click the icon on the right to get your free copy: ||
in a Web-based slide viewer, which is somewhat slower.
If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137.
Click here to download handout in 1-up pdf format for the current section (898 KB)
Click here to download handout in 6-up pdf format for the current section (233 KB)
HRCT shows multiple odd shaped nodules of soft tissue density, many containing air bronchograms. The CT differential includes neoplastic disease, in particular multicentric adenocarcinoma and lymphoproliferative disease. There are no CT features to narrow the wide differential.
TBBx negative, BAL negative – proceeded to surgical lung biopsy. Two firm nodules were sampled from the periphery of the lung.
Case 5 - Slide 1
Case 5 - Figure 1
Standard section from a CT (lower lobes) shows nodules of varying size and shape, the larger of these containing an air bronchogram.
Case 5 - Figure 2
Standard section from a CT (upper lobes) shows multiple nodules of varying size and shape. The dominant lesion in the periphery has a ground-glass halo.
Case 5 - Figure 3
Areas of consolidation comprise discrete and coalescent non-necrotising granulomas filling alveoli and the interstitium.
Case 5 - Figure 4
Langhans-type giant cells are seen within areas of granulomatous inflammation.
Case 5 - Figure 5
Granulomas are seen in close apposition to a pulmonary vessel.
- Almeida FA et al. Coexistent sarcoidosis and HIV
infection: an immunological paradox? J Infect. 2006 Mar;52(3):195-201.
- Amin DN, Sperber K, Brown LK, Chusid ED, Teirstein
AS. Positive Kveim test in patients with coexisting sarcoidosis and human immunodeficiency virus
infection. Chest 1992; 101:145-46.
- Baumer I, Zissel G, Schlaak M, Muller-Quernheim J.
Th1/Th2 cell distribution in pulmonary sarcoidosis. Am J Respir Cell Mol Biol 1997; 16:171-7.
- Busi Rizzi E et al. Radiological patterns in
HIV-associated pulmonary tuberculosis: comparison between HAART-treated and non-HAART-treated patients.
Clin Radiol. 2003;58:469-73.
- Bonnet F et al. Malignancy-related causes of death
in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy.
Cancer. 2004 Jul 15;101(2):317-24
- Cadranel J et al. Lung cancer in HIV infected
patients: facts, questions and challenges. Thorax. 2006 Nov;61(11):1000-8
- Calabrese LH et al. Semin
Arthritis Rheum. 2005 Dec;35:166-74.
- Conron M, Du Bois RM. Immunological mechanisms in
sarcoidosis. Clin Exp Allergy 2001; 31:543-54.
- Coots LE, Lazarus AA. Sarcoidosis diagnosed in a
patient with known HIV infection. Chest 1989; 96:201-2.
- Foulon G et al. Sarcoidosis in HIV-infected
patients in the era of HAART.
- Clin. Infect. Dis.
- Haramati LB, Lee G, Singh A, Molina PL, White CS.
Newly diagnosed pulmonary sarcoidosis in HIV-infected patients. Radiology 2001; 218:24-26.
- Gowda KS , Mayers I, Shafran SD. Concomitant
sarcoidosis and HIV infection. CMAJ 1990; 142:136-7.
- Kalter S, Lopez-Berestein G. Acquired immune
deficiency syndrome in a patient with prior sarcoidosis: case report with monocyte function studies.
Tex Med 1985 Sep;81(9):44-6.
- Lasalle S et al. Sarcoid-like lesions associated
with the immune restoration inflammatory syndrome in AIDS: absence of polymerase chain reaction
detection of Mycobacterium tuberculosis in granulomas isolated by laser capture microdissection. Virchows Archive 2006;449:689-96
- Ledergerber B, Egger M, Erard V, et al.
AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the
Swiss HIV Cohort Study. JAMA 1999; 282:2220-6.
- Lenner R, Bregman Z, Teirstein AS, DePalo L.
Recurrent pulmonary sarcoidosis in HIV-infected patients receiving highly active antiretroviral therapy.
Chest 2001; 119:978-81
- Lowery WS, Whitlock WL, Dietrich RA, Fine JM.
Sarcoidosis complicated by HIV infection: three case reports and a review of the literature. Am Rev
Respir Dis 1990; 142:887-9.
- Maggi E, Mazzetti M, Ravina A, et al. Ability of
HIV to promote a TH1 to TH0 shift and to replicate preferentially in TH2 and TH0 cells. Science 1994;
- Morris DG, Jasmer RM, Huang L, Gotway MB, Nishimura
S, King TE Jr. Sarcoidosis following HIV infection: evidence for CD4(+) lymphocyte dependence. Chest
- Newman TG, Minkowitz S, Hanna A, Sikand R, Fuleihan
F. Coexistent sarcoidosis and HIV infection: a comparison of bronchoalveolar and peripheral blood
lymphocytes. Chest 1992; 102:1899-901.
- Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl
J Med 1997; 336:1224-34
- Palella FJ Jr, Delaney KM, Moorman AC, et al.
Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection.
HIV Outpatient Study Investigators. N Engl J Med 1998; 338:853-60.
- Park WB et al. Immune reconstitution inflammatory
syndrome in the first year after HAART: influence on long-term clinical outcome. AIDS. 2006 Nov 28;20:2390-2.
- Sanchez JM et al. Impact of highly active
antiretroviral therapy on the morbidity and mortality in Spanish human immunodeficiency virus-infected
children. Pediatr Infect Dis J. 2003;22:863-7.
- Shelburne SA III et al. Immune reconstitution
inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy.
Medicine (Baltimore) 2002; 81:21327.
- Wanke CA , Epidemiological and clinical aspects of
the metabolic complications of HIV infection the fat redistribution syndrome, AIDS 13 1999;13: 1287-1293
- Whitlock WL, Lowery WS, Dietrich RA.
Bronchoalveolar lavage in sarcoidosis and HIV infection. Chest 1990; 98:517. 7.