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Child treated for HIV. Have necrotizing granulomas. Having malaise, runny nose and sinus infection. Is it TB?

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Practicing since : 1973
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Hi Doctor. My 3 year old son who was born HIV+ and is recieving HAART treatment quickly grew a lump on his upper arm. He had the lump excised and they biopsied it and found it to be Necrortizing Granulomas. He was adopted from another country and has been healthy up until the last 3 months or so - with chronic sinus infections, general malaise and constant runny nose that seems to not go way with antibiotic. The results were passed back to his infectious disease doctor who is not seeing him for a couple of weeks to discuss. Im concerned and feel its possibly more urgent. The results came in 5 days ago. My concern is TB (although when skin tested it was negative 5 months ago once he arrive in U.S.) as well as Wegeners Granulitis (sp?). What are other possibilities and how will he be tested for these and how urgent do you feel this case is?
Posted Tue, 28 May 2013 in General Health
Answered by Dr. S. Jegadeesan 4 hours later

Thanks for your query.

I understand your problem and apprehension. Yours problem and apprehension are meaningful.
Your 3 Yr old adopted son was born with Human immunodeficiency virus (HIV) and has been healthy up until the last 3 months. You have adopted him from another country and he is on HAART (highly active anti retroviral therapy). A lump developed in his upper arm which was excised and the Biopsy report was Necrortizing Granulomas. He is also suffering from chronic sinus infections, general malaise and constant runny nose, which is not relieved by antibiotic. When he arrived from US 5 months back the skin test was negative for TB. Your present doubt is whether it may due to Wegeners Granulitis.

By this time you know very well that your son is suffering from immune deficiency. This may be cause for the granuloma and respiratory infection. Pulmonary and extra pulmonary TB is common in immune deficiency. We may prevent significant number of HIV infected individuals from complications of tuberculosis if tuberculosis is detected early and treated promptly. This will ensure prolongation of median life of patients with tuberculosis, as HIV & TB are known to modify the clinical characteristics of each other.

Regarding the granuloma it is necrotizing granuloma (etiology is difficult to assess - granulomatous conditions of diverse etiologies share common cytological features) no need to worry right now.
Regarding Wegeners Granulitis is a different condition need not be associated with immune deficiency. Wegener's granulomatosis produces a type of inflammatory tissue known as a granuloma that's found around the blood vessels.

Your treating Dr. is aware of all these things. As your family physician, he may not be in a position to explain what is the cause and exact prognosis and future outcome. Kindly follow his advice and hope for the best.

Best wishes,
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