Sarcoid-like pulmonary disorder in human immunodeficiency virus-infected patients receiving antiretroviral therapy

We report two cases of HIV-infected patients who presented with diffuse int erstitial micronodular lesions on chest X-ray after institution of protease inhibitor-containing highly active antiretroviral therapy (HAART). Granulo matous pulmonary disorder mimicking sarcoidosis was diagnosed on histopatho logical studies revealing noncaseating granuloma and bronchoalveolar lavage analysis showing an intense CD4(+) lymphocyte alveolitis. Causative agents such as infectious organisms and environmental compounds were excluded. Th e relationship between sarcoid-like reaction and immune reconstitution unde r HAART is discussed.