BUZLU CAM OPASİTESİ OLAN HASTALARDA HIV ENFEKSİYONU DÜŞÜNMEK

Öz

Buzlu cam opasitesi, Yüksek Çözünürlüklü Bilgisayarlı Tomografi (YÇBT)de vasküler ve bronşial yapıları örtmeden akciğer dansitesindeki sisli artışı tanımlayan bir terimdir. Nonspesifik bir bulgudur ve ayırıcı tanısı akut alveolar hastalıkları, enfeksiyöz durumları ve kronik interstisyel hastalıkları içeren geniş bir yelpazede değerlendirilir. Bu olgu sunumuyla, buzlu cam dansitesinden yola çıkarak Human Immunodeficiency Virus (HIV) enfeksiyonu tanısına ulaşılan bir hastayı sunmak istedik. Olgumuzda yaygın buzlu cam opasitesi olması akla ilk olarak fırsatçı enfeksiyon nedenlerini getirmiştir. Ancak hastamızdan aldığımız hikayede HIV ile ilişkili olabilecek cinsel bir temas, kan transfüzyonu ya da imuunsupresif bir durum yoktu. Buna karşın hastaya HIV zemininde gelişen Pneumocystis jiroveci Pnomonisi (PJP) ve Cytomegalovirus (CMV) enfeksiyonu tanısı konuldu. Ülkemizde HIV pozitif olan ya da şüpheli cinsel teması olan hastalar bu durumu gizleme eğilimindedirler. Bu nedenle fırsatçı enfeksiyonla uyumlu klinik, radyolojik ve laboratuvar bulguları olan hastalar yaşına ve anamnezine bakılmaksızın mutlaka HIV yönünden araştırılmalıdır.

Anahtar Kelimeler

• Buzlu cam opasitesi, CMV pnomonisi, HIV, PJP

THINKING HIV INFECTION IN PATIENTS WITH GROUND-GLASS OPACITIES

Öz

Ground-glass opacification/opacity is a descriptive term referring to a hazy area of increased attenuation in the lung with preserved bronchial and vascular markings on the High Resolution Computerized Tomography. It is a non-specific sign and the differential diagnosis of ground-glass opacities are evaluated in a wide range including infection, chronic interstitial disease and acute alveolar disease. In this case report, we describe a patient who was diagnosed with Human Immunodeficiency Virus (HIV) infection based on the ground-glass opacities. In our case, diffuse groundglass opacities brought to mind first as the cause opportunistic infections. However, Pneumocystis jiroveci Pneumonia (PJP), Cytomegalovirus (CMV) and fungal infections often occur in the conditions of immunosuppression. In his medical history, there was no an immunosuppressive condition, sexual contact or blood transfusion, which may be associated with HIV. Even so, the patient was diagnosed with CMV and PCP, developed on the basis of HIV. In our country, the patients tend to hide this condition of suspicious sexual contact or HIV positivity. Therefore, patients who have clinical, radiological and laboratory findings consistent with opportunistic infections should be investigated with the suspicion of HIV regardless of age and anamnesis.

Anahtar Kelimeler

• Ground-glass opacity, CMV pneumonia, HIV, PJP

Kaynakça

1. 1. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246(3):697-722.
2. 2. Collins J, Stern EJ. Ground-glass opacity at CT: the ABCs. AJR Am J Roentgenol 1997;169(2): 355-67.
3. 3. Huang L, Cattamanchi A, Davis JL, Boon Sd, Kovacs J, Meshnick S, et al. HIV-associated Pneumocystis pneumonia. Proc Am Thorac Soc 2011;8(3):294-300.
4. 4. Kanne JP, Yandow DR, Meyer CA. Pneumocystis jiroveci pneumonia: high-resolution CT findings in patients with and without HIV infection. American Journal of Roentgenology 2012; 198(6): W555-W61.
5. 5. Fujii T, Nakamura T, Iwamoto A. Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features. Journal of infection and chemotherapy 2007;13(1):1-7.
6. 6. Kuhlman JE, Kavuru M, Fishman EK, Siegelman SS. Pneumocystis carinii pneumonia: spectrum of parenchymal CT findings. Radiology 1990; 175(3):711-4.
7. 7. Chow C, Templeton PA, White CS. Lung cysts associated with Pneumocystis carinii pneumonia: radiographic characteristics, natural history, and complications. AJR Am J Roentgenol 1993;161(3):527-31.
8. 8. Chaffey M, Klein J, Gamsu G, Blanc P, Golden J. Radiographic distribution of Pneumocystis carinii pneumonia in patients with AIDS treated with prophylactic inhaled pentamidine. Radiology 1990;175(3):715-9.

9. 9. Huang L, Stansell J, Osmond D, Turner J, Shafer KP, Fulkerson W, et al. Performance of an algorithm to detect Pneumocystis carinii pneumonia in symptomatic HIV-infected persons. CHEST Journal 1999;115(4):1025-32.
10. 10. Boiselle PM, Crans Jr C, Kaplan MA. The changing face of Pneumocystis carinii pneumonia in AIDS patients. AJR Am J Roentgenol 1999;172(5):1301-9.
11. 11. Özlü T, Metintaş M, Karadağ M, Kaya A. Solunum sistemi ve hastalıkları: İstanbul Tıp Kitabevi; 2010.
12. 12. Salomon N, Gomez T, Perlman DC, Laya L, Eber C, Mildvan D. Clinical features and outcome of HIV related cytomegalovirus pneumonia. Aids 1997;11(3):319-24.
13. 13. Silva RMd, Bazzo ML, Borges AA. Induced sputum versus bronchoalveolar lavage in the diagnosis of pneumocystis jiroveci pneumonia in human immunodeficiency virus-positive patients. Brazilian Journal of Infectious Diseases 2007;11(6):549-53.
14. 14. Uberti-Foppa C, Lillo F, Terreni MR, Puglisi A, Guffanti M, Gianotti N, et al. Cytomegalovirus pneumonia in AIDS patients: value of cytomegalovirus culture from BAL fluid and correlation with lung disease. CHEST Journal 1998;113(4):919-23.