A 32-year-old HIV-positive homosexual man was admitted to the hospital in September 1986 for tonic-clonic seizure activity, weight loss, diarrhea and low-grade fever. His past medical history was significant for chronic hepatitis. Head CT scan and lumbar puncture were normal. An EEC showed abnormal slowing without lateralizing signs and he was treated with diphenylhydantoin. He was readmitted two months later with severe sore throat, fever, chills, myalgia, headache and chest pain. Physical examination revealed a temperature of 38°C, oral candidiasis, bilateral axillary lymphadenopathy and rhonchi in the left posterior lung field. Chest roentgenogram showed diffuse interstitial infiltrates (Fig 3).
Bronchoscopy demonstrated mild chronic bronchitis. Transbronchial biopsies were nondiagnostic; all stains and cultures for P carinii, fungi and mycobacteria were negative. He was treated for presumed atypical pneumonia with erthromycin. A second bronchoscopy performed five days later was also nondiagnostic. Because of radiographic progression and continued fevers an open-lung biopsy was performed two weeks later which revealed immunoblas-tic lymphoma with positive staining for both kappa and lambda chains. There was no evidence of pleural or mediastinal involvement. However, microscopic examination revealed neoplastic cells in pleural plaques as well as subpleural lymphatics.
He received one course of doxorubicin, cyclophosphamide, ec-toposide and prednisone with some symptomatic improvement but the chest roentgenogram remained unchanged. His course was complicated by a cathetei^related S epidermidis bacteremia and worsening interstitial infiltrates on chest roentgenogram. His bacteremia was effectively treated but no further chemotherapy was administered. He died four months after his initial diagnosis of lymphoma. No autopsy was performed.
Figure 3. Chest roentgenogram with interstitial infiltrates (case 3).