A 32-year-old woman was admitted one year after being diagnosed with lymph node tuberculosis and AIDS. She had received treatment with rifampicin, hydrazine, and pyrazinamide for 6 months, as well as zidovudine and didanosine, which were used irregularly. She presented with a 2-month history of evening fever, progressive dyspnea, cough, hemoptysis, weight loss (4 kg in 2 months), and generalized adenomegaly.
At admission, her weight was 53 kg and and her height was 1.70 m. Physical examination showed the patient to be ill-looking, emaciated, pale, acyanotic and afebrile. Her blood pressure was 90/60 mm Hg, her pulse rate was 110 beats per minute, and her respiratory rate was 36 breaths per minute. Cervical, submandibular, and axillary lymphadenopathy were noted. There was crackles in the middle third of the lungs bilaterally. Multiple erythematous macules were observed on the lower limbs.
Laboratory tests showed the following: erythrocytes 2,900/mm3, hemoglobin 8.5 g/dL, hematocrit 29.1%, leukocytes 5,570/mm3 (band neutrophils 5%, segmented neutrophils 64%, eosinophils 3%, lymphocytes 10%), platelets 138,000/mm3. On 3 L/min supplemental oxygen performed by nasopharyngeal catheter, the patient's blood pH was 7.40, her arterial oxygen tension (PaO2) was 52.3 mm Hg, arterial carbon dioxide tension (PaCO2) 33.8 mm Hg, and peripheral oxygen saturation (SaO2) 89.3%. Additional laboratory tests revealed blood urea nitrogen at 18 mg/dL, creatinine at 0.5 mg/dL, CD4 at 252 cells/mm3 (18%), and CD8 at 812 cells/mm3 (58%). Ziehl Neelsen's stain for acid-fast bacilli of the sputum was negative.
The chest radiograph revealed mild interstitial infiltration predominantly in perihilar regions. High-resolution computed tomography (CT) showed peribronchovascular interstitial thickening, with small parenchymatous nodules and discrete thickening of interlobular septa. There was also a small right pleural effusion (Figures 1, 2 and 3). Skin biopsy of a lesion on the left leg showed KS. Open lung biopsy was performed and showed a bronchial involvement by KS. Staining for fungi and mycobacteria were negative.
When results of the biopsy were received, the patient was started on chemotherapy with vincristine 2 mg, doxorubicin 30 mg, and bleomycin 15 mg once daily. The patient responded well to treatment, with improvement in her systemic symptoms and regression of the pulmonary lesions. One year after the end of chemotherapy, the patient is asymptomatic.