Newly diagnosed pulmonary sarcoidosis in HIV-infected patients

PURPOSE: To determine the radiologic and clinical features of newly diagnos ed pulmonary sarcoidosis in human immunodeficiency virus (HIV)-infected pat ients. MATERIALS AND METHODS: Ten HIV-infected patients (seven women, three men; a ge range, 26-66 years; mean age, 37 years) with newly diagnosed sarcoidosis between 1989 and 1997 were retrospectively identified, Charts were reviewe d for the interval between the two diagnoses, CD4 cell count, signs or symp toms, angiotensin-converting enzyme level, and initiation of highly active antiretroviral therapy (HAART). Chest radiographs (n = 10) and computed tom ographic (CT) scans (n = 8) were assessed for lymphadenopathy, pulmonary no dules, focal consolidation, reticular or granular opacities (thickened inte rlobular septa and ground-glass opacities at CT), cysts or cavities, and fi brosis. RESULTS: Mean interval between the two diagnoses was 3 years. Mean CD4 cell count was 213 cells per cubic millimeter. When sarcoidosis was diagnosed, eight patients had pulmonary signs or symptoms. The angiotensin-converting enzyme level was elevated in five of six patients; two developed sarcoidosi s after beginning HAART. Chest radiographs revealed lymphadenopathy, pulmon ary nodules, focal consolidation, reticular opacities, granular opacities, and cysts or cavities. Chest CT scans revealed lymphadenopathy, nodules, th ickened interlobular septa, focal consolidation, reticular opacities, groun d-glass opacities, and cysts or cavities. There was no relationship between the radiographic findings of sarcoidosis and the CD4 cell count. CONCLUSION: The radiologic features of newly diagnosed sarcoidosis in HIV-i nfected patients resemble the findings of sarcoidosis in non-HIV-infected p atients. In HIV-infected patients receiving HAART, sarcoidosis may be a man ifestation of disease related to restoration of the immune system.