The lymphoid lesions associated with the acquired immunodeficiency syndrome

In the present epidemic of opportunistic infections affecting homosexual men, systemic, persistent, unexplained lymphadenopathies have frequently accompanied and often preceded other manifestations of the acquired immunodeficiency syndrome (AIDS). Studies of the lymphadenopathies associated with AIDS have not yet been published, and the lymph node lesions have been generally considered to represent reactive lymphoid hyperplasia. The present study concerns the lymph node biopsies of 36 homosexual males with systemic, persistent lymphadenopathy. The lesions were essentially uniform and consisted of focal hemorrhages, extreme hyperplasia of germinal centers, extensive cellular destruction, accumulation of neutrophils, phagocytosis of nuclear debris, proliferation of blood vessels, immunoblasts, and peculiar aggregates of clear cells. These lesions diagnosed as acute lymphadenitis accompanied diseases indicative of AIDS in six cases and preceded them by months in three cases. In two cases, the lymphadenitis was associated with Kaposi's sarcoma of lymph node and in two cases with non-Hodgkin's lymphomas. It is suggested that the systemic, persistent lymphadenitis of homosexual males is induced by a microorganism, probably a virus. The lymphotropic activity of such an agent may include the destruction of a certain class of lymphocytes leading to the induction of the acquired immunodeficiency syndrome. Under special, unknown circumstances, the uncontrolled lymph node hyperplasia may progress to the development of lymphoma.