The spectrum of pathologic lesions in spleen in patients with acquired immunodeficiency syndrome: Autopsy report of 257 patients.

Publisher: Medknow Country of Publication: India NLM ID: 7605904 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 0974-5130 (Electronic) Linking ISSN: 03774929 NLM ISO Abbreviation: Indian J Pathol Microbiol Subsets: MEDLINE

Publication: Mumbai : Medknow
Original Publication: Chandigarh : Indian Association of Pathologists & Microbiologists.

Spleen*/pathology ; Autopsy* ; Acquired Immunodeficiency Syndrome*/complications ; Acquired Immunodeficiency Syndrome*/pathology; Humans ; Female ; Male ; Retrospective Studies ; Adult ; India/epidemiology ; Middle Aged ; Young Adult ; Adolescent ; Splenic Diseases/pathology ; HIV Infections/complications ; Child ; Aged

Background: Human immunodeficiency virus (HIV) infection continues to persist in India over the past three decades. The involvement of the spleen in these patients has a wide array of differentials with opportunistic infections and malignancies. The spectrum of splenic lesions in patients with HIV/AIDS has not been described in the Indian literature.
Materials and Methods: A retrospective study was designed to understand the spectrum of splenic pathology in patients with HIV/AIDS. The specimens of the spleen obtained at autopsy in 257 patients over a period of 29 years were systematically analyzed.
Results: Among 257 patients, 197 (77%) were males and 60 (23%) were females with a heterosexual route of transmission in 246 (96%) patients. There were 236 (92%) patients from the pre-highly active anti-retroviral therapy era, while 21 (8%) patients had received highly active anti-retroviral therapy for a short duration. The most frequent splenic pathology identified was tuberculosis, noted in 135 (52%) patients, manifesting as military lesions (119 patients, 46%), tuberculous abscesses (13 patients, 5%), and tuberculosis associated with splenic infarcts (03, 1%) patients. The other pathologies noted were cryptococcosis in 17 (7%) patients, malarial infection in 13 (5%) patients, and cytomegalovirus infection in 01 (0.5%) patient. The other findings identified were chronic passive venous congestion, perivascular fibrosis, hemosiderosis, and amyloidosis. In addition, absence or depletion of lymphocyte was noted in 98 (38%) patients and in 4 (1.5%) patients diffuse large B-cell lymphoma was found.
Conclusions: Patients with HIV/AIDS presenting with splenic lesions have a wide array of differentials, such as tuberculosis, opportunistic infection, and the lymphoma. This study provides a better insight into the splenic lesions in patients with AIDS in India.
(Copyright © 2023 Copyright: © 2023 Indian Journal of Pathology and Microbiology.)

India HIV estimates 2019 report New Delhi:NACO, ministry of health and family welfare, government of India. National AIDS control organization and Indian council of medical research-national institute of medical statistics (2020) [Cited 2021 Jan 28]. Available from: http:www.aidsdatahuborg/resource/india-hiv-estimates-2019 report . Accessed on 2023 Jan 03.
Ioachim HL, Lerner CW, Tapper ML. The lymphoid lesions associated with the acquired immunodeficiency syndrome. Am J Surg Pathol 1983;7:543–53.
Joshi VV. Pathology of childhood AIDS. Pediatr Clin of North Am 1991;38:97–120.
Osborne BM, Guarda LA, Butler JJ. Bone marrow biopsies in patients with acquired immunodeficiency syndrome. Hum Pathol 1984;15:1048–53.
Smith FJ, Mathieson JR, Cooperberg PL. Abdominal abnormalities in AIDS:Detection at US in a large population. Radiology 1994;192:691–5.
Ansovini R, Barbolini G, Migaldi M, Botticelli L, De Rienzo B. AIDS splenomegaly and related iron problems. Pathologica 1998;90:133–9.
The coroners Act, 1871 –Indian kanoon. High courts of jurisdiction at Fort William and Bombay, Act No. 4 of 1871, 1 [27 th January 1871]. Central Government Act. Available from: https:indiakanoon.org/doc/792853 Accessed on January 03, 2023.
Coroners Maharashtra repeal Act, 1999. High court of jurisdicature at Bombay (now Brihan Mumbai) [26 th July, 1999] Part VIII:27–29. Available from http:legalcrystal.com Accessed on January 03, 2023.
Diaz LK, Murphy RL, Phair JP, Variakojis D. The AIDs autopsy spleen:A comparison of the pre-anti-retroviral and highly active anti-retroviral therapy eras. Mod Pathol 2002;15:406–12.
Lanjewar DN, Wagholikar UL. Autopsy report of a case of AIDS. Natl Med J India 1990;3:119–21.
Lanjewar DN. The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in Mumbai, India. Patholog Res Int 2011;2011:547618. doi:10.4061/2011/547618. (PMID: 10.4061/2011/547618)
Lanjewar DN, Rao RJ, Kulkarni SB, Hira SK. Hepatic pathology in AIDS:A pathological study from Mumbai, India. HIV Medicine 2004;5:253–7.
Lanjewar DN, Duggal R. Pulmonary pathology in patients with AIDS:An autopsy study from Mumbai. HIV Medicine 2001;2:266–71.
Lanjewar DN, Ansari MA, Shetty CR, Maheshwari MB, Jain PP. Renal lesions associated with AIDS-an autopsy study. Indian J Pathol Microbiol 1999;42:63–8.
Lanjewar DN, Jain PP, Shetty CR. Profile of central nervous system pathology in patients with AIDS:An autopsy study from India. AIDS 1998;12:309–13.
Lanjewar DN, Katdare GA, Jain PP, Hira SK. Pathology of the heart in acquired immunodeficiency syndrome. Indian Heart J 1998;50:321–5.
Lanjewar DN, Anand BS, Genta R, Maheshwari MB, Ansari MA, Hira SK, et al. Major differences in the spectrum of gastrointestinal infections associated with AIDS in India versus the west:An autopsy study. Clin Infect Dis 1996;23:482–5.
Reichert CM, O'Leary TJ, Levens DL, Simrell CR, Macher AM. Autopsy pathology in the acquired immune deficiency syndrome. Am J Pathol 1983;112:357–82.
Welch K, Finkbeiner W, Alpers CE, Blumenfeld W, Davis RL, Smuckler EA, et al. Autopsy findings in the acquired immune deficiency syndrome. JAMA 1984;252:1152–9.
Niedt GW, Schinella RA. Acquired immunodeficiency syndrome. Clinicopathologic study of 56 autopsies. Arch Pathol Lab Med 1986;109:727–34.
Klatt EC, Meyer PR. Pathology of the spleen in the acquired immunodeficiency syndrome. Arch Pathol Lab Med 1987;111:1050–3.
Falk S, Müller H, Stutte HJ. The spleen in immunodeficiency syndrome (AIDS). Pathol Res Pract 1988;183:425–33.
Falk S, Stutte HJ. The spleen in HIV infection-morphological evidence of HIV-associated macrophage dysfunction. Res Virol 1990;141:161–9.
Markowitz GS, Factor SM, Borczuk AC. Splenic para-amyloid material:A possible vasculopathy of the acquired immunodeficiency syndrome. Hum Pathol 1998;29:371–6.
Kalantari S, Paydary K, Soleimani A, Jamali S, Hajiabdolbaghi M. Isolated splenic tuberculosis in a HIV-positive patient:A case report. Arch of Clin Microbiology 2011;2:1–3.
Arab M, Mansoori D, Abbasidezfouli A, Sjadmehr M, Afsari M. Splenic tuberculosis:A case report. Acta Medica Iranica 2002;40:26–8.
Pramesh CS, Tamhankar AP, Rege SA, Shah SR. Splenic tuberculosis and HIV-1 infection. The Lancet 2002;359:353.
Ahmed A, Denue BA, Hammagabdo A. Isolated tuberculous splenic abscess in a HIV-positive patient. Sub-Saharan Afr J Med 2016;3:53–6.
Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004;120:316–53.
Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, et al. Clinical characteristics and prognostic factors of splenic abscess:A review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006;12:460–4.
Bernabeu-Wittel M, Villanueva JL, Pachón J, Alarcón A, López-Cortés LF, Iciana P, et al. Etiology, clinical features and outcome of splenic micro abscesses in HIV-infected patients with prolonged fever. Eur J Clin Microbiol Infect Dis 1999;18:324–9.
Abbas H, Patel H, Baiomi A, Niazi M, Vakde T, Chilimuri S. A rare case of splenic pneumocystis jirovecii in a HIV-positive patient. Case Rep Gastrointest Med 2020;2020:8509591.
Rockley PF, Wilcox CM, Moynihan M, Hewan-Lowe K, Schwartz DA. Splenic infection simulating lymphoma:An unusual presentation of disseminated Pneumocystis carinii infection. South Med J 1994;87:530–6.
O'Neal CB, Ball SC. Splenic pneumocystosis:An atypical presentation of extrapulmonary Pneumocystis infection. AIDS Read 2008;18:503–8.
Galimberti A, Morandi E, Giani G, Vitri P, Piraneo S, De Pasquale L, et al. Pneumocystosis of splenic localization in the course of HIV infection:A new indication for splenectomy:Description of a case. Ann Ital Chir 1997;68:559–62.
Arora VK, Kumar SV. Pattern of opportunistic pulmonary infections in HIV sero-positive subjects:Observations from Pondicherry, India. Indian J of Chest Dis Allied Sci 1999;41:135–44.
Noy A. Update in HIV-associated lymphoma. Curr Opin Oncol 2004;16:450–4.
Navarro WH, Kaplan LD. AIDS-related lymphoproliferative disease. Blood 2006;107:13–20.
Whitehead A, Noy A. Successful treatment of marginal zone lymphoma with splenectomy alone despite HIV infection. AIDS 2007;21:1655–66.
Das P, Chattopadhyay NR, Chatterjee K, Choudhuri T. Kaposi's sarcoma associated herpesvirus related malignancy in India, a rare but emerging member to be considered. Virus disease 2020;31:209–19.
Ablashi D, Chatlynne L, Cooper H, Thomas D, Yadav M, Norhanom AW, et al. “Seroprevalence of human herpesvirus- 8 (HHV-8) in countries of Southeast Asia compared to the USA, the Caribbean and Africa.”. Br J Cancer 1999;81:893–7.
Nolan DJ, Rose R, Rodrigues PH, Salemi M, Singer EJ, Lamers SL, et al. The spleen is an HIV-1 sanctuary during combined antiretroviral therapy. AIDS Res and Hum Retroviruses 2018;34:123–5.

Date Created: 20240223 Date Completed: 20240730 Latest Revision: 20240730

20250114

10.4103/ijpm.ijpm_985_22

38391364