Pathologic features of the lung in the acquired immune deficiency syndrome (AIDS): an autopsy study of seventeen homosexual males.

The lungs of 17 homosexual males who died of the acquired immune deficiency syndrome were studied to determine the type and extent of pulmonary disease present at autopsy. All patients had two or more pathologic processes, including one or more infections in their lungs. Cytomegalovirus pneumonia was the most common pulmonary infection identified at autopsy (15 patients) but was documented morphologically rarely during life (two patients). Most patients with Pneumocystis pneumonia had recurrent or persistent pneumocystosis. Although some of these individuals had evidence of early interstitial fibrosis, others showed complete resolution of the pulmonary changes. Diffuse alveolar damage was observed in 12 patients, and cytomegalovirus and/or Pneumocystis carinii was a likely etiologic agent in each instance. Mycobacterium avium-intracellulare infection was identified in four patients but was not associated with significant pulmonary alterations. Kaposi's sarcoma was found in the lungs of six patients. Early pulmonary involvement appeared as interstitial infiltrates with progression to nodular tumor masses obliterating the underlying lung. Pulmonary hemorrhage was an important complication of Kaposi's sarcoma involving the lung.