This condition occurs more commonly in children; it is unusual in HIV-infected adults. Parotid enlargement and lymphocytic infiltration of the liver and bone marrow may accompany pulmonary involvement. Patients often present with slowly progressive dyspnoea and cough, symptoms that cannot be distinguished from infection. Examination of the chest may be normal or reveal fine end inspiratory crackles. The chest radiograph usually shows bilateral reticulonodular infiltrates but may show diffuse shadowing and thus mimic P. carinii pneumonia. Diagnosis is made by transbronchial biopsy or open lung biopsy. Some patients have been shown to respond to HAART and others to treatment with prednisolone 60 mg once a day.
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