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Follicular bronchiolitis in an HIV-infected individual on combination antiretroviral therapy with low CD4+ cell count but sustained viral suppression
  1. Line D Rasmussen1,
  2. Court Pedersen1,
  3. Helle D Madsen2,
  4. Christian B Laursen2
  1. 1Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
  2. 2Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
  1. Correspondence to Dr Line D Rasmussen, linedahlerup{at}


A 36-year-old Danish man, living in Asia, was diagnosed with Pneumocystis pneumonia (PCP) and HIV in 2013 (CD4+ count: 6 cells/µL; viral load: 518 000 copies/mL). He initiated combination antiretroviral therapy. Later that year, he was also diagnosed with granulomatosis with polyangiitis and was treated with prednisolone. Despite complete viral suppression and increasing CD4+ count (162 cells/µL), he was readmitted with PCP in April 2015. Subsequently, he returned to Denmark (CD4+ count: 80 cells/µL, viral suppression). Over the following months, he developed progressive dyspnoea. Lung function tests demonstrated severely reduced lung capacity with an obstructive pattern and a moderately reduced diffusion capacity. High resolution computer tomography revealed minor areas with tree-in-bud pattern and no signs of air trapping on expiratory views. Lung biopsy showed lymphocytic infiltration surrounding the bronchioles with sparing of the alveolar septa. He was diagnosed with follicular bronchiolitis. The patient spontaneously recovered along with an improvement of the immune system.

  • hiv / aids
  • interstitial lung disease
  • lung function

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  • Contributors Conception and design: LDR and CBL. Interpretation of the data: all authors. Drafting of the article: LDR and CBL. Critical revision of the article for important intellectual content, final approval of the version published and agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved, final approval of the article and acquisition of data/patient: all authors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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