Bilateral pulmonary nodules in an HIV-infected patient

Although infectious causes are the most common source of pulmonary nodules in HIV-infected patients, malignant diseases such as Kaposi sarcoma and lymphoma must also be considered. A 40 year-old man, diagnosed with HIV infection 16 years earlier and with a satisfactory viro-immunological control, was hospitalized for bilateral pulmonary nodules and a dorsal lytic mass. Bone and pleural biopsies showed a malignant epithelioid hemangioendothelioma. Epithelioid hemangioendothelioma is an uncommon low grade vascular tumor. We report the first case in an HIV-infected patient. Bilateral pulmonary nodules are common in this malignant disease but are not specific. In a HIV-infected patient, such clinical presentation is associated with numerous differential diagnoses and must be interpreted in relation to the immune status. In HIV-patients without immunosuppression, pulmonary nodules are often malignant. With the increased survival of these patients, these etiologies closer to those of non-infected patients.