title: [A case of AIDS with Pneumocystis jirovecii pneumonia which required differentiation from ANCA-related lung disease].
abstract: A 41-year-old man with fever, diarrhea and skin rash received a diagnosis of drug-induced lupus. He was given corticosteroids for 3 months and was subsequently admitted to a local hospital due to dyspnea. Pneumonia was then diagnosed and he was given a new quinolone antibacterial agent. Despite this treatment, his symptoms and signs gradually worsened and he was referred to our hospital. High resolution CT (HRCT) of the chest showed diffuse ground-glass opacities, reticular shadows, parenchymal abnormalities, traction bronchiectasis, a subpleural curvilinear shadow and septal lines. Serological examinations were positive for anti-myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) and subsequent HRCT findings were consistent with ANCA-related lung disease. However, the patient had complications such as previous syphilis infection, oral candidiasis, herpes zoster, hepatitis B virus and cytomegalovirus infection. Additionally, his serum was positive for HIV antibody and HIV-1 RNA, and therefore we diagnosed AIDS. His bronchoalveolar lavage fluid revealed Pneumocystis jirovecii. It is known that HIV infection is associated with many types of autoantibodies including MPO-ANCA. Therefore, in HIV/AIDS patients with interstitial lung diseases, it is important to differentiate opportunistic Pneumocystis pneumonia infection from collagen vascular disease-associated interstitial lung diseases.
authors.affiliation: Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University Hospital, Kumamoto University.
authors.forename: Nahoko
authors.initials: N
authors.lastname: Takeda
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ichiyasu
authors.forename: Akiko
authors.initials: A
authors.lastname: Kijima
authors.forename: Daisuke
authors.initials: D
authors.lastname: Notsute
authors.forename: Naoki
authors.initials: N
authors.lastname: Saita
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kohrogi
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis*; D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic; D003937:Diagnosis, Differential; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis*; D008297:Male; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic