The Annals of Thoracic Surgery, Vol 38, 494-499, Copyright © 1984 by The Society of Thoracic Surgeons
Comparison of biopsy-proven Pneumocystis carinii pneumonia in acquired immune deficiency syndrome patients and renal allograft recipients
RP Sterling, BB Bradley, KG Khalil, RH Kerman and RH Conklin
Pneumonia unresponsive to antibacterial agents in patients with acquired
immune deficiency syndrome (AIDS) has become a new indication for lung
biopsy. In 14 patients, transbronchial or open-lung biopsy demonstrated
Pneumocystis carinii. An additional 12 patients, who were immunosuppressed
after renal transplantation, were seen with P. carinii pneumonia. The
diagnosis was established by transbronchial biopsy in the majority of
patients. All patients were treated initially with trimethoprim plus
sulfamethoxazole. Pentamidine was added after diagnosis if improvement did
not occur. Both groups demonstrated reversal in the T cell helper:
suppressor ratio. We compared these two groups of immunocompromised
patients with respect to clinical presentation, lung pathology, response to
therapy, and survival. Patients with AIDS were seen with a two- to
three-week prodrome of fever, lymphadenopathy, weight loss, and malaise
followed by hypoxia and leukopenia within 12 hours. Transplant patients
became acutely ill with fever and hypoxia within 24 to 36 hours. In both
groups, chest roentgenogram showed bilateral diffuse infiltrates; sputum
cultures were generally negative; and lung biopsy demonstrated Gomori-Jones
periodic acid-methenamine-silver-positive P. carinii. Mortality was
substantially higher in patients with AIDS (50% versus 8%). This difference
may be explained by the fact that the T cell defect in AIDS has an
infectious cause, while the defect in the renal allograft recipient is
pharmacologically mediated.
