Human immunodeficiency virus infection and multilocular thymic cysts

PURPOSE: Pathologic changes of the thymus, often seen in children with the human immunodeficiency virus (HIV), reflect direct invasion by the virus, followed by involution of the gland. A previously unknown form of thymic response to HIV infection, that of a multilocular thymic cyst, is reported. MATERIALS AND METHODS: Findings were examined in three HIV-positive patients, two children and one adult first seen with large thymic masses. RESULTS: All three had large, septate low-attenuation areas at computed tomography consistent with multilocular thymic cysts. The cystic nature of the lesions was confirmed with magnetic resonance imaging in two. Histopathologic examination, performed in two instances, helped establish the diagnosis. All, patients remained in clinically stable condition. They all had parotid gland enlargement and lymphocytic interstitial pneumonia. CONCLUSION: Multilocular thymic cysts are probably another manifestation of the diffuse infiltrative lymphocytosis syndrome, usually associated with a milder course of acquired immunodeficiency syndrome.