Pulmonary manifestations of multicentric Castleman's disease in HIV infection: a clinical, biological and radiological study.
The aim of the present study was to report clinical, radiological and bronchoalveolar lavage (BAL) findings in patients with pulmonary manifestations of HIV-associated multicentric Castleman's disease (MCD). This was a retrospective study of 12 patients with histologically proven MCD. Clinical manifestations were as follows: dyspnoea (nine out of 12 cases), cough (n = 10), bilateral crackles (n = 10), together with high fever, malaise, peripheral lymphadenopathy (n = 12), and hepatosplenomegaly (n = 10). Two patients developed acute respiratory distress syndrome. Chest radiographs and computed tomography scans showed reticular (n = 7) and/or nodular (n = 7) interstitial patterns, with mediastinal lymphadenopathy (n = 9), and bilateral pleural effusion (n = 3). Fibreoptic endoscopy was normal in all cases. BAL analysis showed hypercellularity (n = 6) and/or lymphocytosis (n = 6), and human herpesvirus-8 DNA was detected in two out of two cases. Specific stains and cultures for pathogens were negative. All patients received etoposide and/or vinblastine, and improved after 2-4 days. Relapses were frequent (50 attacks in 12 patients). Six patients developed a non-Hodgkin's lymphoma, and five died. In conclusion, the pulmonary manifestation of HIV-related multicentric Castleman's disease is an acute reticulo-nodular interstitial pneumonitis, associated with severe systemic symptoms and peripheral lymphadenopathy. In bronchoalveolar lavage fluid, cellularity is not specific and human herpesvirus-8 DNA is detected. The clinical course is specific due to a rapid onset and regression, frequent relapses and a high occurrence of non-Hodgkin's lymphoma.
Service de Pneumologie, Hôpital Foch, 40, rue Worth, 92151 Suresnes Cedex, France. amelie_guihot@yahoo.fr
A
A
Guihot
L-J
LJ
Couderc
F
F
Agbalika
L
L
Galicier
P
P
Bossi
E
E
Rivaud
A
A
Scherrer
D
D
Zucman
C
C
Katlama
E
E
Oksenhendler
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001707:Biopsy, Needle; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D001999:Bronchoscopy; D005871:Castleman Disease / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D019380:Anti-HIV Agents