LIP

  • slide 8
  • Prof. Hirschel

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1/8 Case: LIP and HIV encephalopathy

A four year old child presented with convulsions.The chest Xray was compatible with lymphocytic interstitial pneumonia.

2/8 Lymphocytic Interstitial Pneumonia LIP

- Usually in patients with moderate immune suppression and CD4 counts of 100 to 500.- Presenting with cough and dyspnea.- Spontaneous remissions are common.- Diagnosis by exclusion.

3/8 Patient 1, slide # 1

- Long standing HIV infection, HAART with multiple drug resistance and intolerance.- Patient interupted treatment in 10/2001 when CD4 cell count was 285/μL.- Presented with cough and dyspnea on May 2, 2002. pneumonia was suspected and treatment with prednisone and cotrimoxazole started.- Broncho-alveolar lavage showed lymphocytes but no pneumocystis. Cotrimoxazole was stopped after 5 days and prednisone tapered over 4 weeks. HAART was re-started.- Rapid improvement in symptoms.

4/8 LIP case 1, slide #2

- May 2, 2002; Cough and dyspnea. - May 12, 2002; After 10 days of prednisone Improvement in symptoms.

5/8 LIP, case 2

- African patient with approximately 400 CD4 cells, untreated. - Presented with low-grade fever and cough, weight loss of 4 kg, and a right lower-lobe infiltrate. TB was suspected. - However, BAL showed lymphocyte predominance, without acid-fast bacteria and cultures remained negative.- Treatment with moderate doses of prednisone and HAART resulted in disappearance of symptoms.

6/8 LIP, case 3

LIP, case 3. - Presentation with fever, dyspnea and cough, and a CD4 count of 300. - Efforts to find an etiology were unsuccesful, BAL showed lymphocyte predominance. - Patient improved without specific treatment.

7/8 Case 4

Case 4. LIP is particularly frequent in children. This 17 month old, perinatally HIV-infected baby had cough, fever, and tachypnea. CD4 count 1114/μL. An extensive work-up failed to reveal spectific pathogens.

8/8 Case 5: LIP and HIV encephalopathy

A four year old child presented with convulsions. The chest Xray was compatible with lymphocytic interstitial pneumonia.

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