Follicular bronchiolitis in an HIV-infected individual on combination antiretroviral therapy with low CD4+ cell count but sustained viral suppression.

Abstract

A 36-year-old Danish man, living in Asia, was diagnosed with Pneumocystis pneumonia (PCP) and HIV in 2013 (CD4+ count: 6 cells/µL; viral load: 518 000 copies/mL). He initiated combination antiretroviral therapy. Later that year, he was also diagnosed with granulomatosis with polyangiitis and was treated with prednisolone. Despite complete viral suppression and increasing CD4+ count (162 cells/µL), he was readmitted with PCP in April 2015. Subsequently, he returned to Denmark (CD4+ count: 80 cells/µL, viral suppression). Over the following months, he developed progressive dyspnoea. Lung function tests demonstrated severely reduced lung capacity with an obstructive pattern and a moderately reduced diffusion capacity. High resolution computer tomography revealed minor areas with tree-in-bud pattern and no signs of air trapping on expiratory views. Lung biopsy showed lymphocytic infiltration surrounding the bronchioles with sparing of the alveolar septa. He was diagnosed with follicular bronchiolitis. The patient spontaneously recovered along with an improvement of the immune system.

• Authors: Line D Rasmussen, Court Pedersen, Helle D Madsen, Christian B Laursen
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2017 (Nov 29 2017) ISSN: 1757-790X [Electronic] England
• PMID: 29191821 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Chemical References

• Anti-Bacterial Agents
• Anti-HIV Agents
• Anti-Inflammatory Agents
• Azithromycin
• Prednisolone

Topics

• Adult
• Aftercare
• Anti-Bacterial Agents (therapeutic use)
• Anti-HIV Agents (therapeutic use)
• Anti-Inflammatory Agents (therapeutic use)
• Azithromycin (administration & dosage, therapeutic use)
• Bronchiolitis (diagnostic imaging, drug therapy, pathology)
• CD4 Lymphocyte Count (methods)
• Denmark (epidemiology)
• Dyspnea (diagnosis, etiology, physiopathology)
• Granulomatosis with Polyangiitis (diagnosis, drug therapy)
• HIV Infections (diagnosis, drug therapy)
• Humans
• Malaysia
• Male
• Pneumonia, Pneumocystis (complications, diagnosis)
• Prednisolone (administration & dosage, therapeutic use)
• Rare Diseases
• Respiratory Function Tests
• Sustained Virologic Response
• Thailand
• Tomography, X-Ray Computed (methods)
• Treatment Outcome
• Viral Load (drug effects)