Pulmonary Non-Hodgkin's Lymphoma in AIDS

doi:10.1378/chest.96.6.1321

Chest

Volume 96, Issue 6, December 1989, Pages 1321-1326

https://doi.org/10.1378/chest.96.6.1321 Get rights and content

Whereas extralymphatic involvement is common in lymphomas associated with HIV infection, there have been few reports of pulmonary lymphoma. In 648 cases of AIDS reported in Colorado, 40 have had non-Hodgkin's lymphoma. Of these, four have had documented pulmonary involvement and are reported in detail. Clinical manifestations were nonspecific and included fever, weight loss, generalized lymphadenopathy, dyspnea, chest pain and cough. Chest roentgenograms revealed multiple nodules or interstitial infiltrates. Transbronchial biopsy failed to establish the diagnosis in all cases. Three of four patients died four to five months after appearance of pulmonary nodules; one patient with stage IE disease showed slow radiographic progression over 16 months following radiation and chemotherapy and died 18 months after appearance of pulmonary nodules. Pulmonary involvement with lymphoma should be considered in patients with HIV infection, especially if multiple nodules are seen on chest roentgenograms.

Section snippets

Methods

All cases of non-Hodgkin's lymphoma diagnosed from May 1982 through December 1987 reported to the AIDS Surveillence Division of the Denver Disease Control Service were reviewed. Case reports of AIDS, death certificates, clinical records and autopsy reports were reviewed for evidence of pulmonary lymphoma. Where necessary, follow-up information was obtained from physicians. Pulmonary lymphoma was documented by open lung biopsy or autopsy.

Case 1

A 47-year-old homosexual man was diagnosed with AIDS in November 1985 when he presented with Kaposi's sarcoma and a history of severe herpes zoster one month previously. In March 1986, he was admitted to the hospital with dysphagia, dyspnea, fever and progressive weight loss. Physical examination revealed marked volume depletion, cotton wool spots on funduscopic examination compatible with CMV chorioretinitis, oral candidiasis and cutaneous lesions of Kaposi's sarcoma on the left hip and groin.

Results

The demographic, clinical and diagnostic characteristics of four cases of HIV-related non-Hodgkin's pulmonary lymphoma are summarized in Table 1. Three patient were homosexual; one had a history of intravenous drug use. The clinical manifestations were nonspecific in all four patients; two patients had generalized lymphadenopathy, and pulmonary symptoms rarely dominated the clinical picture. Three patients had stage IV disease and one had stage IE disease. Concomitant P carinii pneumonia

Discussion

In 1982, the first case of non-Hodgkin's lymphoma in a patient at risk for AIDS was reported.¹ In the original Centers for Disease Control (CDC) surveillance definition of AIDS, only primary lymphoma of the central nervous system was considered diagnostic of the syndrome. In 1985, however, the definition was revised to include any high-grade B-cell non-Hodgkin's lymphoma in the presence of HIV infection. A recent evaluation of the incidence of non-Hodgkin's lymphoma among never-married men in

ACKNOWLEDGMENTS

We gratefully acknowledge Mara Tahal for typing the manuscript, Carol A. Bujwit for reviewing AIDS surveillance data, and Ken Lichtenstein, M.D., and William Pluss, M.D., for providing clinical information on case 3.

References (30)

DC Doll et al.
Burkitt's lymphoma in a homosexual
Lancet
(1982)
JL Ziegler et al.
Outbreak of Burkitt's-like lymphoma in homosexual men
Lancet
(1982)
SP Kalter et al.
Aggressive non-Hodgkin's lymphomas in immunocompromised homosexual males
Blood
(1985)
MH Kaplan et al.
Neoplastic complications of HTLV-III infection
Am J Med
(1987)
A Balasubramanyam et al.
Malignant lymphoma of the heart in acquired immune deficiency syndrome
Chest
(1986)
PF Jenkins et al.
Non-Hodgkin's lymphoma, chronic lymphatic leukaemia and the lung
Br J Dis Chest
(1981)
SM Garay et al.
Pulmonary manifestations of Kaposi's sarcoma
Chest
(1987)
AM Levine
Non-Hodgkin's lymphomas and other malignancies in the acquired immune deficiency syndrome
Semin Oncol
(1987)
AM Levine et al.
Development of B-cell lymphoma in homosexual men
Ann Intern Med
(1984)
HL Ioachim et al.
Lymphomas associated with the acquired immune dificiency syndrome (AIDS): a study of 35 cases
Cancer Detect Prev
(1987)

HL Ioachim et al.

Lymphomas in men at high rish for acquired immune deficiency syndrome (AIDS)

Cancer

(1985)

JL Ziegler et al.

Non-Hodgkin's lymphoma in 90 homosexual men

N Engl J Med

(1984)

B Safai et al.

Cancers associated with HIV infection

Anticancer Research

(1987)

DM Knowles et al.

Lymphoid neoplasia associated with the acquired immunodeficiency syndrome (AIDS)

Ann Intern Med

(1988)

T Ahmed et al.

Malignant lymphomas in a population at risk for acquired immune deficiency syndrome

Cancer

(1987)

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Pulmonary disorders remain an important complication of HIV infection, even in the current era of potent antiretroviral therapy. Using an integrated approach that combines radiographic pattern recognition with knowledge of a patient's clinical symptoms, laboratory data, immune status level, demographic information, and drug therapy can enhance the interpretation of imaging studies in HIV-infected patients. Although chest radiography remains the mainstay of imaging the HIV-positive patient with respiratory symptoms, CT plays an increasingly important secondary role in selected cases.
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Although most patients with pulmonary Kaposi have skin lesions as well, isolated pulmonary disease may occur. Non-Hodgkin lymphoma is another neoplastic disorder occasionally involving the lungs in patients with HIV infections, although there is usually simultaneous extrathoracic involvement as well.2 Thoracic non-Hodgkin lymphoma can present as diffuse reticulonodular opacities, mediastinal lymph adenopathy, pleural effusions, or focal pulmonary masses.
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Infection with human immunodeficiency virus (HIV) is considered to be the most important public health problem of the twentieth century. HIV-associated respiratory tract infections, including tuberculosis and bacterial pneumonia, are the most important causes of morbidity and mortality in AIDS in the world, and Pneumocystis carinii pneumonia (PCP) is the most common AIDS-defining opportunistic infection in the United States. Many infectious, neoplastic, and other disorders have been linked with HIV infection. A list of HIV-associated respiratory disorders follows:
- Bacterial Infections
  Streptococcus pneumoniae
  Haemophilus influenzae
  Chlamydia pneumoniae
  Pseudomonas aeruginosa
  Staphylococcus aureus
  Moraxella catarrhalis
  Rhodococcus equi
  Mycobacterium tuberculosis
  Mycobacterium avium-intracellulare
  Other nontuberculous mycobacteria
- Protozoal Infections
  Pneumocystis carinii (fungus?)
  Strongyloides stercoralis
  Toxoplasma gondii
- Viral infections
  Cytomegalovirus
  Adenovirus
  Herpes simplex
  Measles
- Fungal infections
  Cryptococcus neoformans
  Histoplasma capsulatum
  Aspergillus fumigatus
  Coccidioides immitis
  Blastomyces dermatitides
- Malignancies
  Kaposi's sarcoma
  Non-Hodgkin's lymphoma
  Carcinoma of the lung
- Other Disorders
  Sinusitis
  Bronchitis/bronchiectasis
  Lymphocytic interstitial pneumonitis
  Nonspecific interstitial pneumonitis
  Bronchiolitis obliterans organizing pneumonia
  Primary pulmonary hypertension
The risk of developing each of these disorders is influenced by genetic factors, place of residence, route of transmission of HIV, prior infections, severity of immunosuppression, and use of prophylactic and antiretroviral medications.1, 19, 27, 33, 46, 71
Since the beginning of the AIDS epidemic, flexible bronchoscopy (FB) has been invaluable in the diagnosis of these disorders. Rigorous assessment of the diagnostic usefulness of bronchoscopy in HIV-infected patients is difficult because large studies comparing the yield of bronchoscopic procedures with the gold standard of open lung biopsy (OLB) or autopsy are lacking; most patients with nondiagnostic bronchoscopic procedures are treated empirically. Nevertheless, a wealth of clinical experience supports the use of the procedure.12, 72, 75, 81
In this article, the usefulness of bronchoscopy in diagnosing the common pulmonary complications associated with HIV infection is discussed. Alternatives to bronchoscopy are briefly reviewed. The information provided is likely to help the clinician plan a diagnostic approach to pulmonary complications of HIV disease.

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: Manuscript received February 3; revision accepted May 22.

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Chest

Clinical InvestigationsPulmonary Non-Hodgkin's Lymphoma in AIDS

Section snippets

Methods

Case 1

Results

Discussion

ACKNOWLEDGMENTS

Lancet

Lancet

Blood

Am J Med

Chest

Br J Dis Chest

Chest

Non-Hodgkin's lymphomas and other malignancies in the acquired immune deficiency syndrome

Semin Oncol

Development of B-cell lymphoma in homosexual men

Ann Intern Med

Lymphomas associated with the acquired immune dificiency syndrome (AIDS): a study of 35 cases

Cancer Detect Prev

Lymphomas in men at high rish for acquired immune deficiency syndrome (AIDS)

Cancer

Non-Hodgkin's lymphoma in 90 homosexual men

N Engl J Med

Cancers associated with HIV infection

Anticancer Research

Lymphoid neoplasia associated with the acquired immunodeficiency syndrome (AIDS)

Ann Intern Med

Malignant lymphomas in a population at risk for acquired immune deficiency syndrome

Cancer

Clinical Investigations
Pulmonary Non-Hodgkin's Lymphoma in AIDS