Pulmonary manifestations of multicentric Castleman's disease in HIV infection: a clinical, biological and radiological study.

Abstract

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.

• Authors: A Guihot, L-J Couderc, F Agbalika, L Galicier, P Bossi, E Rivaud, A Scherrer, D Zucman, C Katlama, E Oksenhendler
• Journal: The European respiratory journal (Eur Respir J) Vol. 26 Issue 1 Pg. 118-25 (Jul 2005) ISSN: 0903-1936 [Print] England
• PMID: 15994398 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-HIV Agents

Topics

• Adult
• Anti-HIV Agents (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Biopsy, Needle
• Bronchoalveolar Lavage Fluid (cytology)
• Bronchoscopy
• Castleman Disease (complications, diagnosis, drug therapy)
• Female
• HIV Infections (complications, diagnosis, drug therapy)
• Humans
• Immunohistochemistry
• Male
• Middle Aged
• Prognosis
• Radiography, Thoracic
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Tomography, X-Ray Computed (methods)
• Treatment Outcome