Isolated lymphadenopathy on chest radiographs of HIV-infected patients.

AIM: To determine the aetiology of isolated intrathoracic lymphadenopathy on chest radiographs of HIV-infected patients. PATIENTS AND METHODS: Over a 40 month span in 1990-1993, 18 HIV-infected patients (13 men, 5 women) from our New York City adult HIV outpatient clinic development isolated intrathoracic lymphadenopathy (defined as intrathoracic nodal enlargement without other persistent abnormalities on chest radiographs). Serial chest radiographs (n = 18), CT scans when available (n = 7), and clinical charts (n = 18) were reviewed retrospectively. RESULTS: Median patient age was 34 (range 25-49) years. The diagnoses associated with adenopathy were Mycobacterium tuberculosis (Mtb) in eight (44%), Mycobacterium avium intracellulare complex (MAC) in four (22%), and Mtb and MAC co-infection in three (17%). Cryptococcal infection, thymic hyperplasia, and spontaneous resolution without diagnosis or treatment occurred in one patient each. In 16 (89%) of the 18 patients, lymphadenopathy was present in more than one nodal station. Enlarged nodes were found in the following sites: paratracheal/tracheobronchial (n = 14), aortopulmonary window (n = 9), hilar (n = 7), anterior mediastinum (n = 3), subcarinal (n = 2), and left paraesophageal (n = 2). CONCLUSION: Mycobacterial infection was the aetiology of isolated intrathoracic lymphadenopathy in 15 of 18 (83%) HIV-infected patients. When an inner city HIV-infected patient presents with isolated intrathoracic lymphadenopathy, we recommend an aggressive work-up for mycobacterial disease.

Pyomyositis in patients with the human immunodeficiency virus: an unusual form of disseminated bacterial infection.

PURPOSE AND PATIENTS: Pyomyositis, a common disease in the tropics, is rare in the continental United States, with approximately 83 cases described in the literature in the past two decades. The occurrence of pyomyositis complicating human immunodeficiency virus (HIV) infection has been reported in 10 patients since 1986. We report six cases of this entity in patients with advanced HIV disease seen in our institution over a 20-month period. A common denominator in all of our patients was muscle injury, induced by either exercise or trauma. Unlike most previous reports of HIV-associated pyomyositis, the clinical picture in our cases was complicated by the development of abscesses in multiple muscle groups, requiring prolonged antimicrobial therapy and repeated drainage procedures for successful management. Interestingly, one patient developed concomitant rhabdomyolysis--an otherwise rare event in classical pyomyositis. Staphylococcus aureus was the predominant infecting organism in this as well as all other series. Of note, we also observed and report the first case, to our knowledge, of gram-negative pyomyositis in an HIV-infected individual. The pathogenic implications of this catalase-producing gram-negative isolate are discussed in the context of neutrophil abnormalities in HIV disease. CONCLUSION: Like tropical pyomyositis, its HIV-associated counterpart appears to be multifactorial in origin. Its recent recognition suggests that, in addition to underlying abnormalities of host defense, factors relating to the prolonged survival of patients with late-stage disease, including myopathy, might play an important contributory role.