Organizing Pneumonia as a Manifestation of Pneumocystis jiroveci Immune Reconstitution Syndrome in HIV-positive Patients

Abstract

Organizing pneumonia (OP) is a nonspecific response to various forms of lung injury. Although patients with human immunodeficiency virus (HIV) infection tend to develop several respiratory disorders, especially infections and malignances, the association of HIV infection and OP is unusual. Pneumocystis jiroveci infection is also rarely associated with OP. We describe the radiologic findings in 2 HIV-positive patients who shortly after introduction of highly active antiretroviral therapy, presented with clinical and radiologic deterioration, despite elevation of the CD4 cell count and viral load decrease. In both patients, clinical and radiologic features were consistent with OP and lung biopsy revealed OP associated with P. jiroveci infection. These findings are consistent with immune reconstitution syndrome due to P. jiroveci.

Immune reconstitution inflammatory syndrome

“…leishmaniasis). An event has typically been considered IRIS, and not a new opportunistic infection, if it occurs within the first 4-8 weeks of ART initiation; however, events attributed to IRIS have occurred later [3][4][5][6][7][8][9][10] (reviewed in [11][12][13][14]). With the exception of IRIS in the context of TB [15], there has been no unifying definition with which to describe this entity and define its scope.…”

Understanding Pathogenesis and Care Challenges of Immune Reconstitution Inflammatory Syndrome in Fungal Infections

“…Furthermore, the lack of a culture technique for P. jiroveci creates an additional challenge to distinguish relapse from IRIS. When performed, especially in organizing pneumonia forms, biopsies also showed granulomatous inflammation [37,41,42,44]. These histopathological results have also been described in liver and renal transplant recipients; however, whether a decrease in immunosuppression was responsible or not for IRIS was unclear [45,46].…”

“…P. jiroveci pneumonia (PJP)-IRIS presents as a recurrence of fever, dyspnea, cough, and night sweat in patients treated for PJP. When performed, a CT scan often shows a recurrence of ground glass opacities; however, many cases also report atypical radiologic manifestations, including nodules, consolidations, and organizing pneumonia [37,41,42]. No adequate diagnostic criteria have been described for this entity.…”

Noninfectious Pulmonary Complications of Human Immunodeficiency Virus Infection

“…Other ILDs have been noted in persons living with HIV in the post-HAART era, including cryptogenic organizing pneumonia (COP) and hypersensitivity pneumonitis (HP). COP has been associated with P jiroveci pneumonia 51 , 52 and is also thought to represent a manifestation of IRIS. Similarly, HP, which results from a disordered CD8 + inflammatory response to an extrinsic allergen, was rarely if ever seen in the pre-HAART era.…”