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Case Reports
. 2025 Feb 15;22(1):19.
doi: 10.1186/s12981-025-00717-9.

Remission of low-grade lymphomatoid granulomatosis with extensive pulmonary involvement following immune restoration via antiretroviral therapy in a newly diagnosed HIV patient

Maria Kogan  1   2 , Antonio Maria Alviano  1   3 , Martina Catalano  4 , Alessandra Casiraghi  5 , Giulia Ghilardi  1   6 , Giovanni Rindone  2 , Luisa Verga  2 , Vincenzo L'Imperio  3 , Carlo Gambacorti Passerini  1   2 , Paolo Bonfanti  1   6 , Giuseppe Lapadula  1   6 , Federica Cocito  2 , Alessandro Soria  7
Affiliations
Case Reports

Remission of low-grade lymphomatoid granulomatosis with extensive pulmonary involvement following immune restoration via antiretroviral therapy in a newly diagnosed HIV patient

Maria Kogan et al. AIDS Res Ther. .

Abstract

Lymphomatoid granulomatosis (LYG) is a rare Epstein-Barr virus (EBV)-driven lymphoproliferative disease that usually arises in the context of reduced immunological surveillance. Based on histology, two forms of the disease are recognized, namely low-grade and high-grade LYG. Clinically, LYG universally involves the lungs and, frequently, also the skin, central nervous system, liver, and kidneys. Here, we present the case of a 55-year-old woman with a difficult-to-diagnose low-grade LYG with symptomatic lung involvement, who concomitantly was newly diagnosed with human immunodeficiency virus (HIV) infection. Rapid immune recovery achieved through antiretroviral therapy led to a complete and sustained clinical and radiological remission of LYG.

Keywords: HIV; Immune recovery; Low-grade histology; Lung infiltrates; Lymphomatoid granulomatosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. Ethical review and approval were waived for this case report with no formal analysis aiming to evaluate the efficacy of a therapeutic approach. The patient has provided written informed consent for publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Serial computed tomography scans showing progressive resolution of the diffuse micronodular interstitial pattern of the lungs following initiation of antiretroviral therapy on 16 November 2022 (A: 26 November 2021; B: 22 September 2022; C: 30 January 2023; D: 30 May 2024)
Fig. 2
Fig. 2
Representative histopathological images of the surgical lung biopsy material. Light microscopy examination showed perivascular aggregates of lymphoplasmacytic elements (A-C), with focal angioinvasion (delimited by the arrows in B). Scattered lymphoid follicles were noted, with CD10+/BCL2- germinal centers (arrows in D and E, respectively) and Cyclin D1- mantle zones (delimited by the arrows in F). An abundant T-cell population (CD3+) was also present (G). This florid cellular infiltrate contained medium to large-sized atypical lymphoid elements, which were found to be CD20+ (H, arrows) / CD30+ (I, arrows) / PAX-5+ (J, arrow) / CD15- (K, arrow) / EBER+ (L, arrow). EBER, Epstein-Barr virus - Encoded small RNAs. H&E, Hematoxylin&Eosin
See this image and copyright information in PMC

References

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