Lymphoid pneumonitis in 50 adult patients infected with the human immunodeficiency virus: Lymphocytic interstitial pneumonitis versus nonspecific interstitial pneumonitis

doi:10.1016/0046-8177(92)90130-U

Human Pathology

Volume 23, Issue 5, May 1992, Pages 529-541

https://doi.org/10.1016/0046-8177(92)90130-U Get rights and content

Abstract

Lymphocytic interstitial pneumonitis (LIP) and nonspecific interstitial pneumonitis (NIP) are pulmonary complications of human immunodeficiency virus (HIV) infection that occur in the absence of a detectable opportunistic infection or neoplasm. We reviewed lung biopsy specimens from 50 adult HIV-infected patients, of whom four had LIP and 46 had NIP. The majority (47 of 50) of specimens from patients with NIP showed mild chronic interstitial pneumonitis ( $CIP NIP$ ), with three showing features of diffuse alveolar damage, organizing phase. In contrast to $CIP NIP$ , the five specimens from four patients with LIP demonstrated more extensive lymphocytic interstitial infiltrates that extended into the alveolar septal interstitium. The majority of the interstitial lymphocytes in both NIP and LIP were of T-cell origin and stained for UCHL-1. The etiologies of NIP and LIP remain unknown. Since the common opportunistic infections were excluded by routine methods, we sought, with special techniques, to investigate whether HIV, Epstein-Barr virus (EBV), or cytomegalovirus (CMV) could be identified in lung biopsy specimens from these patients. By in situ hybridization, we found one LIP specimen with expression of large amounts of HIV RNA primarily within macrophages in germinal centers; in the remaining specimens, occasional cells expressing HIV RNA were found (two LIP and four NIP). Neither CMV nor EBV was found by in situ hybridization in seven specimens; in these same specimens EBV was detected using the polymerase chain reaction in only one case of NIP, similar to results in control specimens. These results, together with the knowledge that lymphocytic pulmonary lesions may be caused by lentiviruses in humans and animals, suggest that HIV plays a significant role in the pathogenesis of both NIP and LIP in adult HIV-infected patients; in contrast, our data do not demonstrate a direct role for either EBV or CMV.

References (69)

VV Joshi et al.
Pathologic pulmonary findings in children with the acquired immunodeficiency syndrome: A study of ten cases
Hum Pathol
(1985)
VV Joshi et al.
Pulmonary lesions in children with the acquired immunodeficiency syndrome: A reappraisal based on data in additional cases and follow-up study of previously reported cases
Hum Pathol
(1986)
JC Morris et al.
Lymphocytic interstitial pneumonia in patients at risk for the acquired immune deficiency syndrome
Chest
(1987)
JM Guillon et al.
Human immunodeficiency virus-related lymphocytic alveolitis
Chest
(1988)
JN Allen et al.
HIV-associated bronchiolitis obliterans organizing pneumonia
Chest
(1989)
DE Stover et al.
Spectrum of pulmonary diseases associated with the acquired immune deficiency syndrome
Am J Med
(1985)
PM Murphy et al.
Acquired immunodeficiency syndrome may present as severe restrictive lung disease
Am J Med
(1989)
DW Chamberlain et al.
Diphenylhydantoin-induced lymphocytic interstitial pneumonia
Chest
(1986)
JA Armstrong et al.
Follicular dendritic cells and virus-like particles in AIDS and AIDS-related lymphadenopathy
Lancet
(1984)
K Tenner-Racz et al.
Altered follicular dendritic cells and virus-like particles in AIDS and AIDS-related lymphadenopathy
Lancet
(1985)

A Le Tourneau et al.

LAV-like viral particles in lymph node germinal centers in patients with the persistent lymphadenopathy syndrome and the acquired immunodeficiency syndrome-related complex: An ultrastructural study of 30 cases

Hum Pathol

(1986)

CJ O'Hara et al.

The ultrastructural and immunohistochemical demonstration of viral particles in lymph nodes from human immunodeficiency virus-related and non-human immunodeficiency virus-related lymphadenopathy syndromes

Hum Pathol

(1988)

F Gyorkey et al.

Retrovirus resembling HTLV in macrophages of patients with AIDS

Lancet

(1985)

NC Dean et al.

Human immunodeficiency virus recovery from bronchoalveolar lavage in patients with AIDS

Chest

(1988)

L Resnick et al.

Detection of $HTLV-III LAV -specific$ IgG and antigen in bronchoalveolar lavage fluid from two patients with lymphocytic interstitial pneumonitis associated with AIDS-related complex

Am J Med

(1987)

WA Andiman et al.

Opportunistic lymphoproliferations associated with Epstein-Barr viral DNA in infants and children with AIDS

Lancet

(1985)

WD Travis et al.

Lung biopsy interpretation in the acquired immunodeficiency syndrome: Experience of the National Institutes of Health with literature review

Prog AIDS Pathol

(1989)

A Rubenstein et al.

Pulmonary disease in children with acquired immune deficiency syndrome and AIDS-related complex

J Pediatr

(1986)

P Solal-Celigny et al.

Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome-related complex

Am Rev Respir Dis

(1985)

RY Lin et al.

Lymphocytic interstitial pneumonitis in adult HIV infection

NY State J Med

(1988)

AF Suffredini et al.

Nonspecific interstitial pneumonitis: A common cause of pulmonary disease in the acquired immunodeficiency syndrome

Ann Intern Med

(1987)

FP Ognibene et al.

Nonspecific interstitial pneumonitis without evidence of Pneumocystis carinii in asymptomatic patients infected with human immunodeficiency virus (HIV)

Ann Intern Med

(1988)

JT Simmons et al.

Nonspecific interstitial pneumonitis in patients with AIDS: Radiologic features

AJR

(1987)

C Hostettler et al.

Phenytoin hypersensitivity with pulmonary involvement in a hemophiliac patient with human immunodeficiency virus infection

Drug Intell Clin Pharm

(1987)

FP Ognibene et al.

The diagnosis of Pneumocytis carinii pneumonia in patients with the acquired immunodeficiency syndrome using subsegmental bronchoalveolar lavage

Am Rev Respir Dis

(1984)

SM Hsu et al.

The use of anti-avidin antibody and avidin-biotin-peroxidase complex in immunoperoxidase technique

Am J Clin Pathol

(1981)

LM Weiss et al.

In situ demonstration of Epstein-Barr viral DNA in viral-associated B cell lymphoproliferations

Am J Pathol

(1989)

LM Weiss et al.

In situ hybridization studies for viral nucleic acids in heart and lung allograft biopsies

Am J Clin Pathol

(1990)

D Shibata et al.

Analysis of DNA sequences in forty-year-old paraffin-embedded thin-tissue sections: A bridge between molecular biology and classical histology

Cancer Res

(1988)

DK Shibata et al.

Detection of human papilloma virus in paraffin-embedded tissue using the polymerase chain reaction

J Exp Med

(1988)

CF Wright et al.

Detection of Epstein-Barr virus sequences in Hodgkin's disease by polymerase chain reaction

Am J Pathol

(1991)

Centers for Disease Control

Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome

MMWR

(1987)

SA Yousem et al.

Follicular bronchitis/bronchiolitis

Hum Pathol

(1985)

J Beinenstock et al.

Bronchial lymphoid tissue. I. Morphologic characteristics

Lab Invest

(1973)

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Original contributionLymphoid pneumonitis in 50 adult patients infected with the human immunodeficiency virus: Lymphocytic interstitial pneumonitis versus nonspecific interstitial pneumonitis

Abstract

Hum Pathol

Hum Pathol

Chest

Chest

Chest

Am J Med

Am J Med

Chest

Lancet

Lancet

Hum Pathol

Hum Pathol

Lancet

Chest

Am J Med

Lancet

Lung biopsy interpretation in the acquired immunodeficiency syndrome: Experience of the National Institutes of Health with literature review

Prog AIDS Pathol

Pulmonary disease in children with acquired immune deficiency syndrome and AIDS-related complex

J Pediatr

Lymphoid interstitial pneumonitis in acquired immunodeficiency syndrome-related complex

Am Rev Respir Dis

Lymphocytic interstitial pneumonitis in adult HIV infection

NY State J Med

Nonspecific interstitial pneumonitis: A common cause of pulmonary disease in the acquired immunodeficiency syndrome

Ann Intern Med

Nonspecific interstitial pneumonitis without evidence of Pneumocystis carinii in asymptomatic patients infected with human immunodeficiency virus (HIV)

Ann Intern Med

Nonspecific interstitial pneumonitis in patients with AIDS: Radiologic features

AJR

Phenytoin hypersensitivity with pulmonary involvement in a hemophiliac patient with human immunodeficiency virus infection

Drug Intell Clin Pharm

The diagnosis of Pneumocytis carinii pneumonia in patients with the acquired immunodeficiency syndrome using subsegmental bronchoalveolar lavage

Am Rev Respir Dis

The use of anti-avidin antibody and avidin-biotin-peroxidase complex in immunoperoxidase technique

Am J Clin Pathol

In situ demonstration of Epstein-Barr viral DNA in viral-associated B cell lymphoproliferations

Am J Pathol

In situ hybridization studies for viral nucleic acids in heart and lung allograft biopsies

Am J Clin Pathol

Analysis of DNA sequences in forty-year-old paraffin-embedded thin-tissue sections: A bridge between molecular biology and classical histology

Cancer Res

Detection of human papilloma virus in paraffin-embedded tissue using the polymerase chain reaction

J Exp Med

Detection of Epstein-Barr virus sequences in Hodgkin's disease by polymerase chain reaction

Am J Pathol

Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome

MMWR

Follicular bronchitis/bronchiolitis

Hum Pathol

Bronchial lymphoid tissue. I. Morphologic characteristics

Lab Invest

Original contribution
Lymphoid pneumonitis in 50 adult patients infected with the human immunodeficiency virus: Lymphocytic interstitial pneumonitis versus nonspecific interstitial pneumonitis