CAVITARY PULMONARY-LESIONS IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

The differential diagnosis of cavitary pulmonary lesions in individual s infected with human immunodeficiency virus (HIV) is broad, especiall y in patients with advanced disease. In patients with Pneumocystis car inii pneumonia, cavitation is an uncommon manifestation of a common di sease. It is unusual in patients with pulmonary cryptococcosis, coccid ioidomycosis, and histoplasmosis but occurs frequently in patients wit h invasive pulmonary aspergillosis. In patients with pulmonary tubercu losis, cavities are more common during earlier stages of HIV disease, when cellular immunity is relatively preserved. Mycobacterium avium co mplex is an uncommon cause of lung disease and infrequently produces c avities. However, Mycobacterium kansasii, is often associated with cav itation. Cavities can complicate any bacterial pneumonia and are espec ially common with pneumonia due to Pseudomonas aeruginosa, Nocardia as teroides, and Rhodococcus equi. Noninfectious causes of cavitary lesio ns are rare, but cavitary lesions caused by pulmonary Kaposi's sarcoma and non-Hodgkin's lymphoma have been reported, Because of the broad d ifferential diagnosis and because most cavities are caused by treatabl e opportunistic infections, a definitive diagnosis is essential.