Tuncer ÖZKISA, Ufuk TURHAN, Mehmet AYDOĞAN, Orhan YÜCEL, Erol KILIÇ, Seyfettin GÜMÜŞ

BUZLU CAM OPASİTESİ OLAN HASTALARDA HIV ENFEKSİYONU DÜŞÜNMEK

Buzlu cam opasitesi, Yüksek Çözünürlüklü Bilgisayarlı Tomografi (YÇBT)de vasküler ve bronşial yapıları örtmeden akciğer dansitesindeki sisli artışı tanımlayan bir terimdir. Nonspesifik bir bulgudur ve ayırıcı tanısı akut alveolar hastalıkları, enfeksiyöz durumları ve kronik interstisyel hastalıkları içeren geniş bir yelpazede değerlendirilir. Bu olgu sunumuyla, buzlu cam dansitesinden yola çıkarak Human Immunodeficiency Virus (HIV) enfeksiyonu tanısına ulaşılan bir hastayı sunmak istedik. Olgumuzda yaygın buzlu cam opasitesi olması akla ilk olarak fırsatçı enfeksiyon nedenlerini getirmiştir. Ancak hastamızdan aldığımız hikayede HIV ile ilişkili olabilecek cinsel bir temas, kan transfüzyonu ya da imuunsupresif bir durum yoktu. Buna karşın hastaya HIV zemininde gelişen Pneumocystis jiroveci Pnomonisi (PJP) ve Cytomegalovirus (CMV) enfeksiyonu tanısı konuldu. Ülkemizde HIV pozitif olan ya da şüpheli cinsel teması olan hastalar bu durumu gizleme eğilimindedirler. Bu nedenle fırsatçı enfeksiyonla uyumlu klinik, radyolojik ve laboratuvar bulguları olan hastalar yaşına ve anamnezine bakılmaksızın mutlaka HIV yönünden araştırılmalıdır.

Anahtar Kelimeler:

Buzlu cam opasitesi, CMV pnomonisi, HIV, PJP

THINKING HIV INFECTION IN PATIENTS WITH GROUND-GLASS OPACITIES

Ground-glass opacification/opacity is a descriptive term referring to a hazy area of increased attenuation in the lung with preserved bronchial and vascular markings on the High Resolution Computerized Tomography. It is a non-specific sign and the differential diagnosis of ground-glass opacities are evaluated in a wide range including infection, chronic interstitial disease and acute alveolar disease. In this case report, we describe a patient who was diagnosed with Human Immunodeficiency Virus (HIV) infection based on the ground-glass opacities. In our case, diffuse groundglass opacities brought to mind first as the cause opportunistic infections. However, Pneumocystis jiroveci Pneumonia (PJP), Cytomegalovirus (CMV) and fungal infections often occur in the conditions of immunosuppression. In his medical history, there was no an immunosuppressive condition, sexual contact or blood transfusion, which may be associated with HIV. Even so, the patient was diagnosed with CMV and PCP, developed on the basis of HIV. In our country, the patients tend to hide this condition of suspicious sexual contact or HIV positivity. Therefore, patients who have clinical, radiological and laboratory findings consistent with opportunistic infections should be investigated with the suspicion of HIV regardless of age and anamnesis.

Keywords:

Ground-glass opacity, CMV pneumonia, HIV, PJP,

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