is described pathologically as a diffuse lymphoid infiltration of the
alveolar septa along lymphatic vessels involving mainly CD8 and T lymphocytes
as well as plasmocytes.6 Clinically, it can present as an asymptomatic
condition with chest x-ray changes or respiratory distress with decreased
DLCO and resting hypoxemia. Typical radiological pattern shows diffuse
pulmonary infiltration with ground glass opacities.7 It is described
predominately in the paediatric HIV population8 but does occur in adult
patients with HIV. Both the clinical presentation and radiological appearance
of the disease has significant overlap with other conditions associated
with HIV such as PCP and other infections making lung biopsy the only
means of confirming the diagnosis. Natural history of this condition
is also variable and ranges from resolution to progression.
The relevance of LIP to this case is that LIP is thought to represent
a 'prelymphoma' with the potential to advance to a true lymphoma. It
is postulated to be caused by a reaction to HIV and/or to EBV8. Treatment
response is variable but has been demonstrated to steroids as well as
to the case discussion:
Discussion of treatment options for the patient in the case included points as to whether he should be started on anteretroviral therapy alone in the context of a long term HIV survivor who had not been exposed to antiretroviral therapy or should he also be started on aggressive chemotherapy.
lengthy discussion and debate, SS was started on both modes of therapy.
His course has been complicated by multiples septic episodes, severe
mucositis, as well as difficulties in accepting his HIV status because
of the stigma this diagnosis holds in the country of his birth. After
6 months of therapy with discouraging results, a decision has been made
to change the focus of his treatment to palliative treatment. It is
impossible to predict whether his course would have been different if
antiretroviral therapy alone had been instituted and the outcome may
not have changed considering the advanced state of his HIV disease.
It is however important for physicians working in the developing world
to appreciated potential differences in both presentation of illness
and response to treatment when treating patients coming from the developing