Necropsy findings in acquired immunodeficiency syndrome: a comparison of premortem diagnoses with postmortem findings

Abstract

Necropsies were performed in 12 patients who fulfilled the Centers for Disease Control (CDC) criteria for acquired immunodeficiency syndrome (AIDS), and the postmortem findings were compared with the premortem diagnoses. All of the patients were men with a male sexual preference and histories of multiple episodes of venereal diseases. Four patients were intravenous drug abusers, while two abused amyl nitrate. All 12 of the patients had evidence of cellular immune deficiency at presentation. The causes of death were a variety of opportunistic infections and neoplasms. Pneumocystis carinii pneumonia was diagnosed prior to death in seven patients. Despite current therapy, all seven of those patients had persistent Pneumocystis carinii pneumonia at necropsy, as well as clinically undiagnosed cytomegalovirus infection. In addition, two cases of acid-fast infections, two of visceral candidiasis, one of pneumocystis pneumonia, one of central nervous system lymphoma, one of gram-negative bacterial pyelonephritis, and one of cutaneous aspergillosis were clinically unrecognized and untreated. Nine patients died with two or more infections. Thus, necropsy is a valuable tool for recognizing clinically undiagnosed infections and malignant disorders in AIDS.