Simultaneous occurrence of lymphoepithelial cysts, cytomegalovirus and mycobacterial infections in the intraparotid lymph nodes of a patient with AIDS

Abstract

We report the unusual simultaneous occurrence of lymphoepithelial cysts, cytomegalovirus (CMV) and mycobacterial infections in the intraparotid lymph nodes of a 52-year-old AIDS patient who died of disseminated mycobacteriosis. Although cytomegalovirosis is a common finding in the salivary glands of HIV patients, the association of CMV inclusions with lymphoepithelial cyst (LC) has not been previously reported. Parotid mycobacterial infection is an uncommon finding, despite its usual disseminated presentation in HIV patients. These data emphasize that in immunosuppressed patients, simultaneous diseases of the parotid gland may occur and should be considered for diagnosis and treatment.

Parotid gland involvement in advanced AIDS

“…In the single case that inclusions were present in the intraparotid lymph nodes, they were found in the epithelial lining of lymphoepithelial cyst. We reported this association elsewhere (Vargas et al , 2001), but it is not clear if CMV may be considered as an etiologic agent for the lymphoepithelial cyst. Values higher than 9% of CMV infection in salivary glands have been reported (Ihrler et al , 1996; Wagner et al , 1996).…”

“…In the initial phase of the disease, inflammatory conditions predominate, usually associated with the action of the HIV itself (Mandel and Hong, 1999). During this period, lymphoepithelial cysts are the most common lesions, affecting 3–6% of HIV patients, causing parotid enlargement and being occasionally the first manifestation of HIV infection (Ihrler et al , 1996; Vargas et al , 2001). Later, infectious conditions supervene.…”

Tongue disease in advanced AIDS

“…Lymphoepithelial cyst affects mainly the parotid gland and may be found in 3–6% of HIV patients (Vargas et al , 2001). We found two patients presenting lymphoepithelial cyst in the posterior region of the tongue.…”

“…These cases represent the first description of lymphoepithelial cysts in the tongue of patients with advanced AIDS. Lymphoepithelial cyst usually occurs in the early stages of HIV infection and is rarely found in advanced AIDS (Vargas et al , 2001). An interesting histologic feature was the absence of lymphoid follicles around the wall of the cysts, a feature usually described in these lesions.…”

Radiology Quiz Case 2: Diagnosis

“…2 They represented fewer than 3% of benign parotid gland masses in the 1970s but have significantly increased since the HIV epidemic. 4,5 Finding the parotid cysts in HIV-positive patients is considered one of the signs of HIV infection. The cysts have a predilection for the lateral aspect of the neck and occur less frequently in the oral cavity or parotid glands.…”