1
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
2
Research Center of Thoracic Oncology (RCTO), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
WHAT IS YOUR DIAGNOSIS? A 28-year-old woman was admitted with a two-month history of dysphagia and a two-week history of non-massive hemoptysis. She had been diagnosed with human immunodeficiency virus (HIV) infection five years earlier and was receiving antiretroviral therapy, although adherence was poor. On admission, she was afebrile and hemodynamically stable. Physical examination revealed multiple violaceous cutaneous plaques on the trunk and extremities. Lung examination was unremarkable. Multiple bilateral, non-tender, mobile cervical lymph nodes were palpable. On abdominal examination, the splenic edge was palpable below the left costal margin. Laboratory studies demonstrated pancytopenia, with a white blood cell count of 2.46 × 10⁹/L (absolute neutrophil count, 1.96 × 10⁹/L), hemoglobin of 10.6 g/dL, and platelet count of 44 × 10⁹/L. The erythrocyte sedimentation rate was 52 mm/h. Her HIV viral load was 1895 copies/mL, and the CD4+ T-lymphocyte count was 7 cells/µL. Contrast-enhanced CT of the neck demonstrated multiple bilateral cervical and supraclavicular lymphadenopathies, the largest measuring approximately 125 × 90 mm, associated with contour deformity and luminal narrowing of the oropharynx. Endoscopic evaluation revealed an erythematous lesion on the mucosal surface of the left nasal cavity; however, further evaluation of the nasopharynx was not feasible because of significant upper airway obstruction. Contrast-enhanced CT of the chest revealed multiple bilateral pulmonary nodules with mediastinal, hilar, and axillary lymphadenopathies (Figure 1). CT of the abdomen demonstrated mild hepatosplenomegaly. Given the presence of pancytopenia and generalized lymphadenopathy, both infectious and hematologic etiologies were considered. Sputum smear examination for acid-fast bacilli and Mycobacterium tuberculosis GeneXpert testing were negative. Bone marrow examination and an excisional biopsy of a cervical lymph node were subsequently performed for diagnostic evaluation. Histopathologic findings from the lymph node biopsy are shown in Figure 2.
Eskandari,A , Rezaei,M , Salimi,B and Marjani,M . (2025). Pulmonary Nodules and Lymphadenopathy in a Patient with Advanced HIV Infection . TANAFFOS (Respiration), 24(4), 408-410.
MLA
Eskandari,A , , Rezaei,M , , Salimi,B , and Marjani,M . "Pulmonary Nodules and Lymphadenopathy in a Patient with Advanced HIV Infection ", TANAFFOS (Respiration), 24, 4, 2025, 408-410.
HARVARD
Eskandari A, Rezaei M, Salimi B, Marjani M. (2025). 'Pulmonary Nodules and Lymphadenopathy in a Patient with Advanced HIV Infection ', TANAFFOS (Respiration), 24(4), pp. 408-410.
CHICAGO
A Eskandari, M Rezaei, B Salimi and M Marjani, "Pulmonary Nodules and Lymphadenopathy in a Patient with Advanced HIV Infection ," TANAFFOS (Respiration), 24 4 (2025): 408-410,
VANCOUVER
Eskandari A, Rezaei M, Salimi B, Marjani M. Pulmonary Nodules and Lymphadenopathy in a Patient with Advanced HIV Infection . TANAFFOS (Respiration). 2025;24(4):408-410.
