Infection and Drug Resistance (Nov 2024)
Positive HIV Screening Test in a Patient with Rapidly Progressive Interstitial Lung Disease: A Case Report
Abstract
Xue Chen,1,* Miaotian Cai,2,* Yingmin Ma,2 Tong Zhang,1,* Yulin Zhang2,3,* 1Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Beijing Research Center for Respiratory Infectious Diseases, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yulin Zhang, Department of Respiratory and Critical Care Medicine, Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China, Email [email protected] Tong Zhang, Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China, Email [email protected]: Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders characterized by inflammation and fibrosis of the pulmonary interstitium, posing significant challenges in identifying their underlying causes. Pneumocystis pneumonia (PCP) is the leading cause of ILD in people living with HIV (PLWH). In individuals with connective tissue diseases, ILD is a frequent complication with significant morbidity and mortality.Methods: A case is presented that details the intricate diagnostic process of rapidly progressive interstitial lung disease (RP-ILD).Results: The patient initially presented with clinical features consistent with ILD, including progressive respiratory symptoms and radiological findings typical of pulmonary inflammation. Coupled with a positive HIV screening result, these findings led to an initial misdiagnosis of PCP, a common opportunistic infection in PLWH. However, despite standard anti-PCP treatment, the patient’s condition did not improve, prompting further diagnostic evaluations. Subsequent investigations revealed the presence of serum anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody, a biomarker strongly associated with rapidly progressive ILD in clinically amyopathic dermatomyositis (CADM).Conclusion: This case report offers a novel perspective on the diagnostic process of ILD, particularly emphasizing the importance of distinguishing false-positive antibodies caused by autoimmune diseases in the context of positive HIV screening tests, thereby improving the accuracy of RP-ILD diagnosis and mitigating the mortality burden associated with this condition.Keywords: interstitial lung disease, HIV false positive, Anti-MDA5 antibody, clinically amyopathic dermatomyositis, autoimmune diseases
