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PATHOLOGY IMAGE OF THE MONTH: Fatal Acute Necrotizing Pneumonia in a Patient with HIV/AIDS.

A 31 year-old African-American woman with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) diagnosed 10 years prior (CD4 count = 6; viral load = 263,360/μL) was admitted to the hospital with new onset of altered mental status, fever, and a productive cough. Laboratories were significant for an elevated aspartate aminotransferase (AST) at 116U/L (<45), hypoalbuminemia at 1.5gm/dL (3.4-5.0) and hyponatremia at 132mmol/L (135-146). Notable was long-standing historical documentation of noncompliance with antiretroviral or prophylaxis therapeutic regimens. In the emergency room, she was given intravenous fluids and supplemental oxygen. She was pan-cultured and treated with broad spectrum antibiotics. She was admitted to the intensive care unit where she subsequently required intubation and blood pressure support. Later that day, hypotension became refractory and she developed pulseless electrical activity and then died. Antemortem blood and sputum cultures were negative. An unlimited autopsy examination was granted under coroner authorization. At the time of autopsy, the decedent was noted to be cachectic with an estimated body weight of less than ninety pounds. A total of 200ml of semi-opaque and viscous fluid was found in the pleural cavities. The lung parenchyma was studded with well-delineated hemorrhagic and necrotic appearing lesions in all five lobes. The right ventricular cardiac chamber was dilated on initial apical cross section. All postmortem bacterial, acid-fast bacillus, and fungal cultures were negative. Representative microscopic images from the lung are demonstrated on the next page in Figure 1.