Intrathoracic lymphadenopathy and HIV infection

Abstract

A 32-year-old homosexual man, known to be HIV-seropositive for 7 years, presented with a 2-month history of a productive cough, night sweats, lethargy, right-sided upper chest discomfort and exertional dyspnoea. He smoked 10–20 cigarettes per day. There was no other relevant past medical history. The patient looked thin and unwell but was afebrile. Small lymph nodes were palpable in the neck, axillae and groin. A chest radiograph showed right paratracheal lymphadenopathy with adjacent ill-defined air-space consolidation in the right upper lobe (Fig. 1). At fibreoptic bronchoscopy the only abnormality was tracheal indentation from the right. Other investigations at presentation included a blood CD4 lymphocyte count of 386/mm³ (normal value > 1000/mm³,) a CD8 lymphocyte count of 1819/mm³, Hb 13.6 g/dl, WBC 10.6 × 10⁹, granulocytes 7.7 × 10⁹/l, lymphocytes 2.7 × 10⁹/1; urea, electrolytes and liver function tests were normal except for an elevated alkaline phosphatase (105 IU/1).