Bronchoalveolar lavage in sarcoidosis and HIV infection.

We read with great interest the case presented byCoots and Lazarus’ concerning a young black man who was found to be HIV positive on routine military screening and developed bilateral hilar lymphadenopathy compared to a chest film taken two years previously. Gallium uptake in the hilar lymph nodes perfklrmed one year later on reevaluation led to a diagnostic thoracotomy, with noncaseating granuloma found in the lung and lymph node biopsy This case raises clinical questions about discerning of sarcoidosis from advanced HIV infection. We have diagnosed a similar case and wish t(I report the utility of bronchoalveolar lavage and flow cytometry in patients with both these diseases. A 37-year--old white man was referred for evaluation of positive HIV serology and sarcoidosis. Medical history revealed a diagnosis of stage I sarcoidosis made in 1977 bymediastinal lymph node biopsy, high risk behavior for HIV infection, and a 30 pack-year smoking history The patient was asymptomatic at the time of initial presentation and had received no therapy. A follow-up chest roentgenogram (CXR) in 1985 showed bilateral hilar and right paratracheal lymphadenopathy without parenchymal disease. HIVpositive serology was detected on routine military’ screening in June, 1987. The patient’s physical examination was normal except for bilateral axillary lymphadenopathy. Laboratory’ evalimation revealed cutaneous anergy and a stable CRX film .Pimlmonaryfunction tests (PFTs) performed in June, 1987 revealed a normal forced vital capacity of 4.62 L (89 percent of predicted), a omue-second forced expiratory volume of3.89 L (97 percent ofpredicted), and a diffusion capacity for carbon monoxide 80 percent of predicted. The patient presented in February, 1988 with increasing dyspnea on exertion and fatigue. Physical examination, PFT, and CXR (Fig 1) film were unchanged. He was referred for evaluation of advanced HIV infection progression of sarcoidosis. Laboratory’ evaluation revealed