Resolution of lymphocytic interstitial pneumonitis in an HIV infected adult after treatment with HAART

The optimal therapy for lymphocytic interstitial pneumonitis (LIP) in HIV infected adults is currently unknown. We describe an HIV patient with LIP who improved with protease inhibitor based highly active antiretroviral therapy (HAART) without concurrent corticosteroids. A 52 year old heterosexual African-American man, diagnosed with HIV infection 3 years before presentation, was hospitalised for an evaluation of an abnormal chest radiograph obtained during medical screening. His CD4+ lymphocyte count was 198 cells ×106/l, and plasma HIV-1 RNA level >290 000 copies/ml. He denied all symptoms, including cough, shortness of breath, chest pain, fever, and weight loss. On admission, vital signs included temperature 37.1°C, respiratory rate 16 breaths/minute, and room air oxygen saturation 94%. Complete physical examination was unremarkable, including pulmonary examination. Laboratory data included white blood cell count 5800 ×106/l. Room air arterial blood gas: pH, 7.42; pCO2, 38 mm Hg; pO2, 70 mm Hg; A-a gradient 33 mm Hg. Chest high resolution computed tomography (HRCT) scan revealed diffuse micronodules and right lower lobe consolidation, without pleural effusions or intrathoracic lymphadenopathy (fig 1A). Pulmonary function tests (PFTs) revealed …