Welcome to Cross-Canada Paediatric - Respiratory Residency Rounds
Page 7 / Case 12.03


LIP is described pathologically as a diffuse lymphoid infiltration of the alveolar septa along lymphatic vessels involving mainly CD8 and T lymphocytes as well as plasmocytes.6 Clinically, it can present as an asymptomatic condition with chest x-ray changes or respiratory distress with decreased DLCO and resting hypoxemia. Typical radiological pattern shows diffuse pulmonary infiltration with ground glass opacities.7 It is described predominately in the paediatric HIV population8 but does occur in adult patients with HIV. Both the clinical presentation and radiological appearance of the disease has significant overlap with other conditions associated with HIV such as PCP and other infections making lung biopsy the only means of confirming the diagnosis. Natural history of this condition is also variable and ranges from resolution to progression.

The relevance of LIP to this case is that LIP is thought to represent a 'prelymphoma' with the potential to advance to a true lymphoma. It is postulated to be caused by a reaction to HIV and/or to EBV8. Treatment response is variable but has been demonstrated to steroids as well as antiretroviral therapy9.

Return to the case discussion:
Discussion of treatment options for the patient in the case included points as to whether he should be started on anteretroviral therapy alone in the context of a long term HIV survivor who had not been exposed to antiretroviral therapy or should he also be started on aggressive chemotherapy.

After lengthy discussion and debate, SS was started on both modes of therapy. His course has been complicated by multiples septic episodes, severe mucositis, as well as difficulties in accepting his HIV status because of the stigma this diagnosis holds in the country of his birth. After 6 months of therapy with discouraging results, a decision has been made to change the focus of his treatment to palliative treatment. It is impossible to predict whether his course would have been different if antiretroviral therapy alone had been instituted and the outcome may not have changed considering the advanced state of his HIV disease. It is however important for physicians working in the developing world to appreciated potential differences in both presentation of illness and response to treatment when treating patients coming from the developing world.

NEXT PAGE 1 2 3 4 5 6 7 8

Archives / Contact us