LETTER
Outpatient Management of HIV-Related Pneumonia
Stephen L. Becker, MD
1 December 1996 | Volume 125 Issue 11 | Page 938
TO THE EDITOR:
The editorial by Masur and Shelhamer [1] is an important addition to the developing literature on practice guidelines for the human immunodeficiency virus (HIV). One point deserves further attention. If sputum studies do not provide a diagnosis and bronchoscopy is planned, transbronchial biopsy and bronchoalveolar lavage should also be done. In cases in which bronchoscopy is required for diagnosis, Pneumocystis carinii pneumonia is not the usual cause and biopsy will also be necessary to establish the diagnosis. In many institutions, bronchoalveolar lavage without transbronchial biopsy is a routine procedure for the diagnosis of P. carinii pneumonia. At our institution, we recently saw cases of so-called classic P. carinii pneumonia (with dyspnea, interstitial infiltrates, hypoxemia, and elevated lactate dehydrogenase levels) that were subsequently proven by biopsy to have been caused by cytomegalovirus, Mycobacterium tuberculosis, lymphocytic interstitial pneumonitis, and coccidioides.
As the natural history of HIV infection continues to change, different and perhaps new opportunistic diseases can be expected. Our diagnostic approaches must evolve to keep up with the changes in the underlying disease.
San Francisco, CA 94107
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California Pacific Medical Center, San Francisco, CA 94107.
1. Masur H, Shelhamer J. Empiric outpatient management of HIV-related pneumonia: economical or unwise? [Editorial] Ann Intern Med. 1996; 124:451-3.
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