Clinical symptoms in patients with pulmonary lymphoma were nonspecific and not useful for diagnostic purposes (Table 1). However, three of four patients in our series did develop catheter-related staphylococcal bacteremia. Jacobsen et al recently documented an increased incidence of S aureus bacteremia in patients with AIDS or AIDS-related complex and found that intravenous catheter placement was the most important risk factor. It has been suggested that AIDS patients may have functional abnormalities of neutrophil migration or intracellular killing of bacteria to explain the increased incidence of S aureus bacteremia. Whether lymphoma per se or chemotherapy also predispose to this complication is unknown.
Antemortem diagnosis of pulmonary involvement in non-Hodgkins lymphoma is difficult. All four patients had transbronchial biopsies which were nondiagnostic. Two patients required open-lung biopsy for diagnosis. In non-AIDS patients, the diagnostic yield of transbronchial biopsy in patients with known non-Hodgkins lymphoma is only 20 percent. However, there have been no studies in which open-lung biopsy has been compared to transbronchial biopsy for the diagnosis of pulmonary lymphoma. In addition, several series have documented a 60 to 80 percent success rate using transthoracic needle aspiration for the diagnosis of lung cancer, but there are few data showing the efficacy of this procedure in the diagnosis of pulmonary lymphoma. Since lung carcinoma is extremely rare in AIDS patients, we feel that the utility of this procedure is very limited in this setting. whitening gel
In summary, our observations are consistent with previous reports of non-Hodgkins lymphomas in AIDS patients in that high-grade histopathology, extranodal involvement and associated opportunistic infections were common. Furthermore, prognosis was poor despite chemotherapy. Involvement of the lungs in patients with non-Hodgkins lymphoma is unusual in patients with HIV infection, but should be considered, particularly when multiple nodules are seen on chest roentgenograms.