[AIDS patient with pneumocystosis and pulmonary alveolar proteinosis].

Pulmonary alveolar proteinosis can be associated with various microorganisms and Pneumocystis jirovecii is one of them, especially in AIDS patients. Authors present the case of a 30-year-old man treated with corticosteroids for idiopathic pulmonary fibrosis, having restrictive ventilatory disfunction and bilateral perihilar interstitial infiltrates, ground-glass opacity on CT of the lungs. Rapid extension ofpulmonary a bnormalities (over a month) to peripheral reticular lesions and presence of fever were considered as Hamman-Rich syndrome. He was admitted to Clinical Hospital of Infectious Diseases and Pneumophtisiology Dr.V.Babes from Timisoara during 5-13 XII 2008 for prolonged fever, night sweats, weight loss, progressive dyspnea, marked hypoxemia, tachycardia. Diagnosis of AIDS was quickly established on two positive ELISA tests, T helper cell count (CD4 = 3 cells/mm3, CD8 = 480 cells/mm3, CD4/CD8 = 0.01) and viral load (200,000 copies/ml). Treatment was started with trimethoprim-sulfamethoxazole, fluconazole, corticosteroids but the patient died. Postmortem pathological examination showed pulmonary alveolar proteinosis and showed P. jirovecii. Pulmonary changes caused by HIV can mimic idiopathic pulmonary fibrosis and HIV may become the new "great imitator". Although the number of subjects infected with HIV is increasing, failure to recognize this immunodeficiency state is still encountered. HIV infection must be kept in mind in the differential diagnosis of each case of prolonged fever.