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Pancreatic disorders in pediatric acquired immune deficiency syndrome
E Kahn1, V M Anderson, M A Greco
1North Shore University Hospital-Cornell University Medical College, Manhasset, NY 11030, USA.
Insights
Pancreatic changes are common in children with acquired immune deficiency syndrome (AIDS) but are typically mild. These findings often reflect broader systemic illness rather than direct pancreatic threats.
Area of Science:
- Pediatric Pathology
- Infectious Diseases
- Gastroenterology
Background:
- Acute pancreatitis affects 17% of pediatric patients with acquired immune deficiency syndrome (AIDS).
- Pancreatitis in this population is associated with a poor prognosis.
- Human immunodeficiency virus (HIV) infection impacts multiple organ systems in children.
Purpose of the Study:
- To describe pancreatic changes in children with HIV infection at autopsy.
- To document the nature, extent, and clinical relevance of these pancreatic alterations.
- To investigate the incidence of opportunistic infections in the pancreas of HIV-infected children.
Main Methods:
- Autopsy examination of pancreatic tissues from 71 children with HIV infection.
- Histopathological analysis to identify specific pancreatic changes.
- Correlation of pancreatic findings with clinical data and causes of death.
Main Results:
- Nonspecific changes like edema, inflammation, fibrosis, and enlarged islets were frequent.
- Acute and chronic pancreatitis were generally mild, with one exception of dideoxyinosine-associated pancreatitis.
- Opportunistic infections (CMV, MAI, Candida) and lymphoplasmacytic infiltration were focal and rare.
Conclusions:
- Pancreatic changes are common in children with AIDS at autopsy.
- These changes are usually mild and secondary to systemic disease.
- Pancreatic involvement by opportunistic infections is infrequent in this cohort.
Abstract:
Acute pancreatitis, reported in 17% of pediatric patients with acquired immune deficiency syndrome (AIDS), is said to have a poor prognosis. We describe the pancreatic changes observed at autopsy from 71 children with human immunodeficiency virus (HIV) infection and document their nature, extent, and clinical relevance. The median age at autopsy of the children was 17 months (range, 2 months to 19 years); 38 were boys and 33 were girls. Parental intravenous drug use was the most frequent risk factor for AIDS, followed by blood transfusions. Respiratory failure and sepsis constituted the predominant causes of death. Nonspecific changes, such as edema, inflammation, fibrosis, inspissated material in acini and ducts, and enlarged Langerhans' islet predominated. Acute and chronic pancreatitis were mild except in one instance of a fatal acute probably dideoxyinosine-associated pancreatitis. Pancreatic involvement by opportunistic infections, such as cytomegalovirus (CMV), Mycobacterium avium intracellulare (MAI), and Candida, was focal and rare despite the high prevalence of these infections at autopsy. Focal lymphoplasmacytic infiltration and vascular calcifications were also observed. We conclude that pancreatic changes were frequently noted at autopsy in children with AIDS. They were usually mild, reflected systemic disease states, and were usually not life threatening. The incidence of opportunistic infections of the pancreas was low.