Chronic plasma cell pneumonia in a patient with long-standing HIV infection.
Chronic bibasilar alveolar infiltrates existed for more than 2 years in a 25-year-old woman infected with HIV for more than a decade. Bronchoscopically, there were copious, purulent secretions that grew methicillin-resistant Staphylococcus aureus (MRSA). Transbronchial biopsy specimens demonstrated plasma cell interstitial pneumonia (PCIP). Focal, transient radiographic improvement occurred after antistaphylococcal antimicrobial therapy. With recurrent and progressive symptoms, sustained clinical and radiographic improvement did not occur until corticosteroid therapy was instituted with tuberculosis chemoprophylaxis. Persistent antigenic stimulation in immunosuppressed patients causes PCIP. In this instance, the stimulus is MRSA. The previous model and support for this theory is Pneumocystis carinii. There is good experimental reason for a plasma cell response in persons infected with HIV. To our knowledge, this is the first case of chronic plasma cell interstitial pneumonia caused by indolent MRSA infection.
Foreman
Marilyn G
MG
Section of Pulmonary and Critical Care, Morehouse School of Medicine, Atlanta, Georgia 30310, USA. foremam@msm.edu
Flenaugh
Eric
E
Stringer
H Gene
HG
Hewan-Lowe
Karlene
K
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D016106:Methicillin Resistance; D010950:Plasma Cells / Q000473:pathology; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007538:Isoniazid