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Updated: May 12, 2026
Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4+ T-cell Immunophenotyping and HIV Reservoir Assessment
Published on: June 23, 2019
Simultaneous diagnosis of cryptogenic organizing pneumonia and HIV in a 45 year old man
Israr A Sheikh1, Naseem Saadia, Naveed Sheikh
1Department of Internal Medicine, Harlem Hospital, New York, NY, U.S.A.
Background:
Cryptogenic organizing pneumonia (COP) is a small airways disease characterized by intraluminal polyps of myxoid connective tissue which follows a subclinical course and is associated with infectious as well as non infectious processes The concomitant occurrence of human immunodeficiency virus (HIV) infection and COP has rarely been reported. We describe a unique case in which COP was a presenting feature in a patient with newly diagnosed HIV Infection.
Case Report:
A 45 year-old man with chronic active smoking presented to the ER with 15 months history of cough productive of minimal whitish sputum without frank or streaks of blood, low grade fever, anorexia and 4-6 lbs weight loss in past 6 months. He had three life time sexual partners. PPD status were unknown. He was extensively worked up as the Chest X ray showed cystic lesions all of which came back normal. Patient also received HIV test which was positive with CD 4 count of 546. He received bronchoscopy which revealed cryptogenic organising pneumonia. He was placed on steroids tapering course which helped in relieving the symptoms.
Conclusions:
HIV infection with CD 4 count above 500 has seldom been reported having COP with this case being the second in literature but this entity should be kept in mind during management of these patients.
Insights
Cryptogenic organizing pneumonia (COP) rarely presents with newly diagnosed human immunodeficiency virus (HIV) infection. This case highlights COP as an initial manifestation in an HIV-positive patient, even with a CD4 count over 500.
Area of Science:
- Pulmonology
- Infectious Diseases
- Immunology
Background:
- Cryptogenic organizing pneumonia (COP) is a small airways disease.
- COP is rarely reported concurrently with human immunodeficiency virus (HIV) infection.
- This case presents COP as a feature of newly diagnosed HIV infection.
Purpose of the Study:
- To describe a unique case of COP presenting in a patient with newly diagnosed HIV infection.
- To highlight the rare association between COP and HIV, particularly with higher CD4 counts.
Main Methods:
- A case report of a 45-year-old male smoker with a 15-month history of respiratory symptoms.
- Diagnostic workup included chest X-ray, HIV testing (CD4 count 546), and bronchoscopy.
- Treatment involved a tapering course of steroids.
Main Results:
- Chest X-ray revealed cystic lesions, but all initial workups were normal.
- HIV test was positive; bronchoscopy confirmed cryptogenic organizing pneumonia.
- Steroid treatment led to symptom relief.
Conclusions:
- HIV infection with a CD4 count above 500 is seldom reported with COP.
- This case is the second reported instance of this association.
- COP should be considered in the management of HIV-infected patients.
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