The development of pulmonary infiltrates in individuals infected with human immunodeficiency virus type 1 (HIV) remains a common clinical problem. This presents the clinician with an extensive differential diagnosis with the focus often on infectious etiologies.
Pulmonary hemorrhage has been reported in association with a number of disorders. Although pulmonary hemorrhage has been reported in immunocompromised hosts,” this entity is not commonly considered in the diagnosis of pulmonary infiltrates in patients with AIDS. We present a retrospective review of two cases of HIV-infected individuals who developed pulmonary infiltrates during the course of their hospitalization. In each case, findings consistent with pulmonary hemorrhage were observed. Source
A 35-year-old white bisexual man was determined to have positive HIV serologic test results 8 months prior to hospital admission (PTA) when he was diagnosed as having Pneumocystis carinii pneumonia. Following complete recovery from P carinii pneumonia, he received monthly aerosolized pentamidine prophylaxis. Additional complications of HIV-related disease included cutaneous Kaposi’s sarcoma, herpetic esophagitis, anemia, and leukopenia.
The patient was hospitalized with a 7-day history of fever, chills, nausea, vomiting, and acute renal failure. Empiric treatment with ceftriaxone and vancomycin was initiated for fevers. Renal biopsy specimen disclosed no evidence for vasculitis, malignancy, or microbial pathogens, including bacterial, fungal, P carinii, or acid-fast bacilli (AFB). Progression to anuric renal failure necessitated hemodialysis.
On the seventh hospital day, the patient developed melena, hematemesis, hematuria, and a hemorrhagic pericardial effusion with tamponade. Developement of small bilateral pulmonary infiltrates prompted the addition of empiric trimethoprim-sulfamethoxazole therapy.