Opportunistic hepatic infections in AIDS patients with fever of unknown origin

The clinical features and histopathologic manifestations of hepatic opportu nistic infections in patients with acquired immunodeficiency syndrome (AIDS ) in Taiwan remain unexplored. We report 28 AIDS patients (25 men, 3 women; mean age, 34 years) with fever of unknown origin who underwent 31 liver bi opsies from December 1995 to May 1997. In most cases, the biochemical tests showed moderate to markedly elevated alkaline phosphatase concentrations, but normal or mildly elevated aminotransferase concentrations. The most com mon histopathologic finding was macrosteatosis, which was noted in 15 of th e 28 patients. Another important histopathologic finding indicating the eti ology of hepatic opportunistic infection was granuloma, which tvas found in 11 patients. Histochemical stain and culture of liver specimens)yielded My cobacterium avium complex (MAC) in eight patients, Mycobacterium tuberculos is in two patients, Histoplasma capsulatum in one patient, and cytomegalovi rus in one patient with concomitant MAC infection. Therefore, a definitive diagnosis in AIDS patients with fever of unknown origin was made in 11 of t he 28 cases with the assistance of liver biopsy. During followup, late extr ahepatic involvement by the same infectious agents was found in six patient s. Thus, hepatic manifestations could be a harbinger of disseminated opport unistic infections in AIDS patients.