Sarcoidosis - Immune Reconstitution Syndrome in HIV patients

1/27/2003

Question:  Can sarcoidosis be a complication of antiretroviral therapy, in what is called the immune reconstitution syndrome? 

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Unique Identifier:11243991

Authors: Lenner R. Bregman Z. Teirstein AS. DePalo L.

Institution: Mount Sinai School of Medicine, Mount Sinai-NYU Health, New York, NY, USA. egandrobi@aol.com

Title: Recurrent pulmonary sarcoidosis in HIV-infected patients receiving highly active antiretroviral therapy.

Source: Chest. 119(3):978-81, 2001 Mar.

Abstract: HIV infection and sarcoidosis occur in the same age group, but there are only a few reports of the coexistence of the two disorders in the same individual. This infrequent occurrence has been attributed to the paucity of functioning CD4(+) lymphocytes required for granuloma formation in patients with HIV infection. We report two patients with a history of remote sarcoidosis who later in life contracted HIV infection and developed recurrent, progressive pulmonary sarcoidosis while receiving highly active antiretroviral therapy (HAART). Progressive pulmonary sarcoidosis should be added to the differential diagnosis in patients receiving HAART for HIV infection who develop diffuse lung disease with recovery of CD4(+) lymphocyte population.

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Unique Identifier:11152809

Authors: Haramati LB. Lee G. Singh A. Molina PL. White CS.

Institution: Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467, USA. lharamati@aecom.yu.edu

Title: Newly diagnosed pulmonary sarcoidosis in HIV-infected patients.

Source: Radiology. 218(1):242-6, 2001 Jan.

Abstract: PURPOSE: To determine the radiologic and clinical features of newly diagnosed pulmonary sarcoidosis in human immunodeficiency virus (HIV)-infected patients. MATERIALS AND METHODS: Ten HIV-infected patients (seven women, three men; age range, 26-66 years; mean age, 37 years) with newly diagnosed sarcoidosis between 1989 and 1997 were retrospectively identified. Charts were reviewed for the interval between the two diagnoses, CD4 cell count, signs or symptoms, angiotensin-converting enzyme level, and initiation of highly active antiretroviral therapy (HAART). Chest radiographs (n = 10) and computed tomographic (CT) scans (n = 8) were assessed for lymphadenopathy, pulmonary nodules, focal consolidation, reticular or granular opacities (thickened interlobular septa and ground-glass opacities at CT), cysts or cavities, and fibrosis. RESULTS: Mean interval between the two diagnoses was 3 years. Mean CD4 cell count was 213 cells per cubic millimeter. When sarcoidosis was diagnosed, eight patients had pulmonary signs or symptoms. The angiotensin-converting enzyme level was elevated in five of six patients; two developed sarcoidosis after beginning HAART. Chest radiographs revealed lymphadenopathy, pulmonary nodules, focal consolidation, reticular opacities, granular opacities, and cysts or cavities. Chest CT scans revealed lymphadenopathy, nodules, thickened interlobular septa, focal consolidation, reticular opacities, ground-glass opacities, and cysts or cavities. There was no relationship between the radiographic findings of sarcoidosis and the CD4 cell count. CONCLUSION: The radiologic features of newly diagnosed sarcoidosis in HIV-infected patients resemble the findings of sarcoidosis in non-HIV-infected patients. In HIV-infected patients receiving HAART, sarcoidosis may be a manifestation of disease related to restoration of the immune system.

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Unique Identifier:10351953

Authors: Naccache JM. Antoine M. Wislez M. Fleury-Feith J. Oksenhendler E. Mayaud C. Cadranel J.

Institution: Services de Pneumologie et de Reanimation Respiratoire, d'Anatomie-Pathologique, et d'Histologie Biologie Tumorale, Hopital Tenon, Paris, France.

Title: Sarcoid-like pulmonary disorder in human immunodeficiency virus-infected patients receiving antiretroviral therapy.

Source: American Journal of Respiratory & Critical Care Medicine. 159(6):2009-13, 1999 Jun.

Abstract: We report two cases of HIV-infected patients who presented with diffuse interstitial micronodular lesions on chest X-ray after institution of protease inhibitor-containing highly active antiretroviral therapy (HAART). Granulomatous pulmonary disorder mimicking sarcoidosis was diagnosed on histopathological studies revealing noncaseating granuloma and bronchoalveolar lavage analysis showing an intense CD4(+) lymphocyte alveolitis. Causative agents such as infectious organisms and environmental compounds were excluded. The relationship between sarcoid-like reaction and immune reconstitution under HAART is discussed. CAS Registry/EC Number 0 (Anti-HIV Agents).