Diffuse alveolar damage and interstitial fibrosis in acquired immunodeficiency syndrome patients without concurrent pulmonary infection.

Patients with acquired immunodeficiency syndrome (AIDS) characteristically present with repeated pulmonary infections. We present the pathologic findings in lung biopsy specimens from 12 patients with AIDS in whom the histologic spectrum ranged from mild diffuse alveolar damage to frank interstitial fibrosis. In all of these patients, there was no evidence of any concurrent infectious process in the lung. Diffuse alveolar damage is a pattern of response of the lung to many kinds of infectious processes and immunologic injury, both of which are potential possibilities in patients with AIDS. This study underscores the development of diffuse alveolar damage or interstitial fibrosis and their presentation as the sole histologic findings in lung biopsy specimens from patients with AIDS. We discuss the possibility that these changes may be long-term sequelae to repeated pulmonary infections with or without an immunologic defect.