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Trabzonlu L, McDermott S, Pitman MB, Chebib I. Pulmonary Kaposi sarcoma in a patient with bilateral lung transplant: An unexpected diagnosis on transbronchial fine needle aspiration and core biopsy. Diagn Cytopathol 2024. [PMID: 38860692 DOI: 10.1002/dc.25368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024]
Abstract
Kaposi sarcoma (KS) is a low-grade vascular neoplasm that can be seen in various sites, most commonly seen in skin and mucosal tissues. Cytologic features of KS have been well-documented in the literature, however, since it is rarely seen in visceral organs, it could pose significant diagnostic challenges on fine needle aspiration (FNA) biopsies. We present a case of pulmonary KS diagnosed on transbronchial FNA biopsy in a 70-year-old female bilateral lung allograft recipient 11 months after transplantation. The aspirate smears showed a moderately cellular specimen containing a mixture of small, tightly cohesive clusters and loosely clustered groups of monomorphic, ovoid to spindled cells with moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel on the concurrent core biopsy showed the tumor cells to be positive for ERG, KIT, and HHV8, confirming the diagnosis. We compared our case to previously published reports of confirmed pulmonary KS in lung allograft recipients.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Seto N, Fukuchi T, Kawakami M, Nagashima M, Sadamasu K, Hatakeyama S. Seronegative HIV-1 infection in a Japanese man presenting with Pneumocystis pneumonia: Analysis of long-term antibody response and literature review. J Infect Chemother 2024:S1341-321X(24)00036-9. [PMID: 38331251 DOI: 10.1016/j.jiac.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/28/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
Seronegative human immunodeficiency virus (HIV) infection, where an HIV-specific antibody response is lacking even in chronic or late-stage HIV infections, is extremely rare. Here, we report the case of a 50-year-old Japanese man presenting with Pneumocystis pneumonia who did not produce antibodies against HIV-1 until the initiation of antiretroviral therapy (ART). Fourth-generation antigen-antibody testing temporarily reverted from weakly positive to negative soon after initiating ART, likely due to a reduction in viral load (assessed by p24 antigen levels). His HIV-1 antibody titers remained low or indeterminate even after four years of ART. A literature review suggested that the absence of HIV-1-specific antibody production may be associated with unimpeded HIV replication and rapid CD4+ T cell decline. Seronegative HIV infection can lead to deferred diagnosis and treatment, thereby increasing the risk of transmitting the virus to others or developing opportunistic illnesses. It is important to combine multiple tests for diagnosis, depending on the medical condition. Further studies are required to investigate the host factors involved in the production of HIV-1-specific antibodies.
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Affiliation(s)
- Nayuta Seto
- Division of General Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takahiko Fukuchi
- Division of General Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Mamiyo Kawakami
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Mami Nagashima
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Kenji Sadamasu
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Department of Infection and Immunity, Jichi Medical University, Tochigi, Japan; Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
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Chuwa F, Kivuma B, Ndege R. Repeated false-negative HIV rapid test results in a patient presenting to care with advanced HIV disease: A case report. IDCases 2023; 31:e01719. [PMID: 36845910 PMCID: PMC9945762 DOI: 10.1016/j.idcr.2023.e01719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Severe immunosuppression has been reported as one of the causes of a false-negative HIV rapid test result. Guidelines on what tests should be performed in adult patients presenting with severe immunosuppression despite a negative HIV rapid test result are lacking. This is the second case report of a false-negative HIV rapid test results in a patient presenting with advanced HIV disease in Tanzania.
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Affiliation(s)
- Francisca Chuwa
- Ifakara Health Institute, Ifakara, the United Republic of Tanzania,St. Francis Referral Hospital, Ifakara, the United Republic of Tanzania
| | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, the United Republic of Tanzania,St. Francis Referral Hospital, Ifakara, the United Republic of Tanzania
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, the United Republic of Tanzania,St. Francis Referral Hospital, Ifakara, the United Republic of Tanzania,Swiss Tropical & Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland,Corresponding author at: Ifakara Health Institute, Ifakara, the United Republic of Tanzania.
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Zhang Y, Wang YY, Li XF, Ma CY, Li J, Kang W, Kang WZ, Wang LX, Huang CX, Sun YT, Lian JQ. A human immunodeficiency virus-seronegative acquired immunodeficiency syndrome patient with opportunistic infections: A case report. Int J STD AIDS 2022; 33:515-518. [PMID: 35227156 DOI: 10.1177/09564624221074507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In rare cases, people living with chronic human immunodeficiency virus (HIV) infection do not develop antibodies despite demonstrable infection. Delayed or missed diagnosis of HIV infection leads to a lack of timely therapy, resulting in rapid disease progression with opportunistic infections or malignancies. CASE REPORT A 44-year-old Chinese man presented with sore throat, oral leukoplakia, fever, dyspnoea and diffuse ground glass-like lesions in both lungs. Serum cytomegalovirus DNA was detectable, and CD4+ T-cell count was low. The patient was suspected of being a person living with HIV despite of the repeatedly negative HIV antibody tests using enzyme-linked immunsorbent assay and Western blot. Subsequently, high-plasma HIV RNA viral load was found on two repeated tests, while HIV DNA was also positive. Thus, the patient was confirmed as presenting with HIV-seronegative acquired immunodeficiency syndrome (AIDS). The symptoms improved in response to effective anti-fungal and anti-retroviral therapy after diagnosis. CONCLUSION This is the third reported case of an HIV-seronegative AIDS patient in China, which are also rarely reported globally. HIV nucleic acid testing is important to screen out HIV infection, especially in those who present with severe immunodeficiency but remain HIV serogenative.
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Affiliation(s)
- Ye Zhang
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yuan-Yuan Wang
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Xiao-Feng Li
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Chun-Yan Ma
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Jing Li
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wen Kang
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Wen-Zhen Kang
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Lin-Xu Wang
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Chang-Xing Huang
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Yong-Tao Sun
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Jian-Qi Lian
- Department of Infectious Diseases, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, Shaanxi Province, China
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Rapp AR, Okorodudu AO, Nguyen DK, Patel JA. A True Negative HIV Antibody Result with an Initially Incorrect Interpretation-A Diagnostic Conundrum in HIV Screening. Clin Chem 2021; 67:1318-1321. [PMID: 34597369 DOI: 10.1093/clinchem/hvab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Alexandra R Rapp
- Department of Pathology, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Anthony O Okorodudu
- Department of Pathology, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Diana K Nguyen
- Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Janak A Patel
- Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX
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Yan S, Huang J, Zheng Q, Zhu H, Gao Z, Feng J, Xu Y. A rare case of an HIV-seronegative AIDS patient with Pneumocystis jirovecii pneumonia. BMC Infect Dis 2019; 19:525. [PMID: 31200652 PMCID: PMC6570926 DOI: 10.1186/s12879-019-4143-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background As technology progresses, several highly sensitive human immunodeficiency virus (HIV) screening kits are being researched and developed to quickly and efficiently identify serum HIV antibodies within the non-window period. In individuals who are HIV-seronegative, HIV infections that are not within a window period are rare. In such cases, all antibody detection methods will fail, and misdiagnosing these patients will have catastrophic consequences. Case presentation A 22-year-old male Chinese patient with diffuse exudative lesions in both lungs and initial symptoms of cough and dyspnoea was diagnosed with Pneumocystis jirovecii pneumonia (PJP) by aetiological examination, and the patient’s plasma CD4+ T-cell count was extremely low. In China, PJP is prevalent in HIV-infected individuals. Pneumocystis jirovecii (P. jirovecii) has a high colonisation rate in patients with HIV infections. This patient was naturally suspected of being an HIV patient; however, serum HIV antibody tests were negative using both an enzyme-linked immunosorbent assay (ELISA) and a latex agglutination assay, and HIV was not detected by western blotting. Subsequently, the plasma HIV viral load was found to be extremely high on two repeated plasma HIV RNA tests, thus confirming HIV-seronegative acquired immunodeficiency syndrome (AIDS) in this patient. With administration of effective anti-P. jirovecii treatment and highly active antiretroviral therapy (HAART) after diagnosis, the patient’s disease condition was rapidly controlled. Conclusion This is the second reported case in China of an HIV-seronegative AIDS patient. Such cases are also rare worldwide. Although HIV-seronegative HIV infections are rare, AIDS should be considered in immunodeficient patients with opportunistic infections, even if the test results are HIV-seronegative. Plasma HIV RNA testing is important for such patients. Electronic supplementary material The online version of this article (10.1186/s12879-019-4143-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuangquan Yan
- Division of Respiratory Medicine, Taizhou Enze Medical Center Enze Hospital, No. 1 East TongYang Load, Luqiao District, Taizhou, Zhejiang, 318000, People's Republic of China
| | - Jing Huang
- Division of Respiratory Medicine, Taizhou Enze Medical Center Enze Hospital, No. 1 East TongYang Load, Luqiao District, Taizhou, Zhejiang, 318000, People's Republic of China
| | - Qiaofei Zheng
- Division of Clinic Laboratory, Taizhou Enze Medical Center TaiZhou Hospital, Taizhou, 318000, Zhejiang, China
| | - Hongguo Zhu
- Division of Clinic Laboratory, Taizhou Enze Medical Center Enze Hospital, Taizhou, 318000, Zhejiang, China
| | - Zhuolin Gao
- Division of Respiratory Medicine, Taizhou Enze Medical Center Enze Hospital, No. 1 East TongYang Load, Luqiao District, Taizhou, Zhejiang, 318000, People's Republic of China
| | - Jiaxi Feng
- Division of Respiratory Medicine, Taizhou Enze Medical Center Enze Hospital, No. 1 East TongYang Load, Luqiao District, Taizhou, Zhejiang, 318000, People's Republic of China
| | - Youzu Xu
- Division of Respiratory Medicine, Taizhou Enze Medical Center Enze Hospital, No. 1 East TongYang Load, Luqiao District, Taizhou, Zhejiang, 318000, People's Republic of China.
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