Nodular pulmonary deposition disease in a patient with the acquired immunodeficiency syndrome: a case report

Abstract

Background: Pulmonary nodules are a common cause for concern in patients with human immunodeficiency virus and acquired immunodeficiency syndrome. Most commonly, they are the result of an infection, given the patients' immunocompromised state; however, in some cases, pulmonary nodules in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome can result from cellular or protein deposits. We report a rare case of nodular pulmonary light chain deposition disease in a patient with acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance.

Case presentation: A 53-year-old African American woman with acquired immunodeficiency syndrome had pulmonary nodules detected incidentally by imaging of her lungs. Pulmonary tuberculosis was high on the differential diagnosis, but she had a negative test result for pulmonary tuberculosis. Imaging also revealed multiple lucent bone lesions, and earlier in the year, serum protein electrophoresis had shown an immunoglobulin G-kappa monoclonal protein (M spike). She was mildly anemic, so there was concern for progression to myeloma; however, the result of her bone marrow biopsy was unremarkable. Lung biopsy revealed finely granular eosinophilic material with negative Congo red staining, consistent with light chain deposition disease.

Conclusions: The extent of this patient's light chain deposition disease was thought to be caused by a combination of acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance, and the interval decrease in lung nodule size after restarting antiretroviral therapy confirms this hypothesis and also highlights a potentially unique contribution of the hypergammaglobulinemia to this disease process in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome .

Keywords: AIDS; HIV; Hypergammaglobulinemia; Light chain deposition disease (LCDD).

Fig. 1

Results of monoclonal serum protein immunofixation. Results showed an elevated serum immunoglobulin G (IgG) level with the presence of an IgG-kappa monoclonal protein with a total serum monoclonal protein level of 327.6 mg/dl

Fig. 2

a and b. Computed tomography images with their corresponding positron emission tomography (PET) images (c and d) showing numerous pulmonary masses and nodules in the lower lung fields (a and c) and in the posterior segment of the left lower lobe (b and d)

Fig. 3

a and b. Computed tomography images with their corresponding positron emission tomography (PET) images (C and D) showing numerous pulmonary masses and nodules in the lower lung fields (a and c) and in the posterior segment of the left lower lobe (b and d)