HIV Lymphadenopathy: Differential Diagnosis and Important Imaging Features

Glushko, Tetiana; He, Lulu; McNamee, William; Babu, Aparna Srinivasa; Simpson, Scott A.

doi:10.2214/ajr.19.22334

Cited by 13 publications

(35 citation statements)

References 51 publications

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“…The KS-associated effusions in our patients showed no differentiating patterns and could also be mistaken for a sign of disseminated TB. In the interpretation of the findings, it should be noted that KS-associated effusions and intra-abdominal lymphadenopathy, have a broad differential diagnosis, including extra-pulmonary TB, disseminated Mycobacterium avium complex (MAC) infection, HIV lymphadenopathy, Hodgkin- or non-Hodgkin lymphoma, and other human herpes virus 8 (HHV-8)-associated illnesses, such as multicentric Castleman disease (MCD) and primary effusion lymphoma [ 8 , 9 ].…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis

et al. 2023

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Background Focused Assessment with Sonography for HIV-associated TB (FASH) is a diagnostic tool for extra-pulmonary tuberculosis (TB) in symptomatic patients with advanced HIV. As Kaposi’s sarcoma (KS) is also prevalent in this patient population, changes due to KS may mimic TB findings and clinical interpretation of target FASH findings can be challenging. We aimed to describe sonographic findings in patients with KS. Methods We performed a prospective observational study at Lighthouse clinic at Kamuzu Central Hospital, Lilongwe, Malawi, in consecutive patients with newly diagnosed KS, without known diagnosis of TB, referred for paclitaxel treatment. All patients underwent FASH and abdominal ultrasound to assess for effusions and changes in liver and spleen, as well as systematic sonographic assessment for lymphadenopathy. Results We included 30 patients. We found inguinal lymph nodes using ultrasound in 20 patients; in 3 (10%) additionally abdominal lymph nodes were found. Pathological effusions were seen in eight patients (27%): pericardial effusion in one (3%), pleural effusion in six (20%) and ascites in four (13%) patients. We found focal spleen lesions in three (10%) patients. Most of these lesions were echogenic, but in one patient, we saw hypoechoic lesions with an echogenic center. In three (10%) patients an unusual “sponge-like pattern” of the splenic vasculature was found. Six (20%) patients had echogenic focal lesions in the liver resembling hemangiomas, individual lesions showing a hypoechoic center. In two patients echogenic portal fields were seen. Conclusions The majority of patients with newly diagnosed KS demonstrate sonographic features of disease, predominantly lymphadenopathy. Effusions were observed in a significant minority, as well as focal lesions in liver or spleen, which commonly resemble hemangiomas, but hypoechoic lesions were also observed and can easily be mistaken for extra-pulmonary TB. A 'sponge-like pattern' of the spleen should not be confused with micro-abscesses. In conclusion, this case series illustrates the diverse nature of ultrasound features in patients with KS, which can be difficult to distinguish from other opportunistic diseases, including TB.

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Section: Conclusion and Discussionmentioning

confidence: 99%

Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis

et al. 2023

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“…Immune reconstitution inflammatory syndrome (IRIS) should also be considered as a possible cause of lymphadenopathy in patients who start HAART. The incidence of lymphadenopathy is negatively correlated with CD4 counts ( 26 ). Due to the different respective treatments and adverse effects of over treatment, it is vital to distinguish HIV-associated lymphoma from benign lymphadenopathy.…”

Section: Pet To Distinguish Lymphoma From Benign Lesionsmentioning

confidence: 99%

Clinical value of 18F-FDG PET/CT in the management of HIV-associated lymphoma

et al. 2023

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HIV is still a major public health problem. At present, HIV-associated lymphoma remains the leading cause of deaths among people living with HIV, which should be paid more attention to. 18F-fluorodeoxglucose (FDG) PET/CT has been recommended in the initial staging, restaging, response assessment and prognostic prediction of lymphomas in general population. HIV-associated lymphoma is, however, a different entity from lymphoma in HIV-negative with a poorer prognosis. The ability to accurately risk-stratify HIV-infected patients with lymphoma will help guide treatment strategy and improve the prognosis. In the review, the current clinical applications of 18F-FDG PET/CT in HIV-associated lymphoma will be discussed, such as diagnosis, initial staging, response evaluation, prognostic prediction, PET-guided radiotherapy decision, and surveillance for recurrence. Moreover, future perspectives will also be presented.

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“…In this condition, lymphoproliferation is often reactive to the infection and presents with multiple or localized lymphadenopathies, which are initially featured by follicular hyperplasia with subsequent germ center involution. 7 In patients with lower CD4+ counts, persistent HIV-related lymphadenopathy can be observed, more frequently involving the neck; 7 furthermore, in HIV patients the possibility of another underlying infectious etiology for lymphoproliferative features (ie mycobacteria) should always be screened.…”

Section: Introductionmentioning

confidence: 99%

The Etiologic Landscape of Lymphoproliferation in Childhood: Proposal for a Diagnostic Approach Exploring from Infections to Inborn Errors of Immunity and Metabolic Diseases

Costagliola,

De Marco,

Massei

et al. 2024

TCRM

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Lymphoproliferation is defined by lymphadenopathy, splenomegaly, hepatomegaly, or lymphocytic organ and tissue infiltration. The most common etiologies of lymphoproliferation are represented by infectious diseases and lymphoid malignancies. However, it is increasingly recognized that lymphoproliferative features can be the presenting sign of rare conditions, including inborn errors of immunity (IEI) and inborn errors of metabolism (IEM). Among IEI, lymphoproliferation is frequently observed in autoimmune lymphoproliferative syndrome (ALPS) and related disorders, common variable immunodeficiency (CVID), activated phosphoinositide 3-kinase δ syndrome, and Epstein-Barr virus (EBV)-related disorders. Gaucher disease and Niemann-Pick disease are the most common IEMs that can present with isolated lymphoproliferative features. Notably, other rare conditions, such as sarcoidosis, Castleman disease, systemic autoimmune diseases, and autoinflammatory disorders, should be considered in the differential diagnosis of patients with persistent lymphoproliferation when infectious and malignant diseases have been reasonably ruled out. The clinical features of lymphoproliferative diseases, as well as the associated clinical findings and data deriving from imaging and first-level laboratory investigations, could significantly help in providing the correct diagnostic suspicion for the underlying etiology. This paper reviews the most relevant diseases associated with lymphoproliferation, including infectious diseases, hematological malignancies, IEI, and IEM. Moreover, some practical indications to orient the initial diagnostic process are provided, and two diagnostic algorithms are proposed for the first-level assessment and the approach to persistent lymphoproliferation, respectively.

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HIV Lymphadenopathy: Differential Diagnosis and Important Imaging Features

Cited by 13 publications

References 51 publications

Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis

Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis

Clinical value of 18F-FDG PET/CT in the management of HIV-associated lymphoma

The Etiologic Landscape of Lymphoproliferation in Childhood: Proposal for a Diagnostic Approach Exploring from Infections to Inborn Errors of Immunity and Metabolic Diseases

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