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Neuropathy in diffuse infiltrative lymphocytosis syndrome

An HIV neuropathy, not a lymphoma

From the Groupe d'Etude et de Recherche sour le Muscle et le Nerf (GERMEN)(Drs. Gherardi, Chrétien, Authier, and Bélec), Créteil; Département de Pathologie (Drs. Gherardi and Authier), Hôpital Henri Mondor, Créteil; Laboratoire des Mycoplasmes (Drs. Chrétien and Roulland-Dussoix), Institut Pasteur, Paris; Service d'Immunologie biologique (Dr. Delfau-Larue), Hôpital Henri Mondor, Créteil; Service de Neurologie (Dr. Moulignier), Fondation Adolphe de Rothschild, Paris; Laboratoire de Virologie (Dr. Bélec), Hôpital Broussais, Paris, France.

Address correspondence and reprint requests to Dr. Romain K. Gherardi, Département de Pathologie, Hôpital Henri Mondor, 94 010 Créteil Cedex, France.

Objective: To determine whether CD8 lymphoid infiltrates in nerves of patients with HIV-associated diffuse infiltrative lymphocytosis syndrome (DILS) corresponds to a lymphomatous neoplastic process or to a proliferation of T cells reactional to HIV.

Background: DILS is characterized by persistent CD8 hyperlymphocytosis and multivisceral CD8 T-cell infiltration, which may affect peripheral nerves.

Methods: Presence of monoclonal T cells and HIV-1 proviral load were evaluated by polymerase chain reaction (PCR) techniques in frozen peripheral nerve samples from six patients with DILS neuropathy and 22 patients with other HIV-associated peripheral neuropathies, including mononeuritis multiplex(MM:6), inflammatory demyelinating polyneuropathies (IDP:6), distal sensory polyneuropathy (DSP:5), and toxic distal sensory polyneuropathy (TDSP:5).

Results: Five of six patients with DILS showed no detectable monoclonal T-cell clones in their nerves. Nerve proviral load in DILS (6.8 ± 0.2 log/10⁵ cells) was much higher than in MM (p < 0.008), IDP (p < 0.001), DSP (p < 0.001), and TDSP(p < 0.005).

Conclusions: DILS neuropathy represents a separate entity among HIV-associated neuropathies. It is associated with massive HIV proviral load in nerve and must not be confused with a peripheral nerve T-cell lymphoma.

Supported by grants from a Projet Hospitalier de Recherche Clinique AP-HP, the Association Claude Bernard, Sidaction, and the Agence Nationale de Recherches contre le SIDA.

Received July 18, 1997. Accepted in final form October 7, 1997.

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