Adenoidal Enlargement in HIV+ Patients

Epidemiology

Enlargement of the nasopharyngeal adenoidal tissue is well established. Adenoidal tissue is normally enlarged in children and young adults. This tissue usually regresses by the fourth to fifth decades of life. Hypertrophy of the adenoidal tissue has been reported in up to 60% of patients who are HIV+. The enlargement is believed to be due to reactive lymphoid hyperplasia and may even occur in HIV+ patients who have undergone prior adenoidectomy. There does not appear to be any substantial relationship between adenoidal width in HIV+ patients and CD4 count, hematocrit, or white blood count.

Clinical Findings

Patients with nasopharyngeal adenoidal hypertrophy typically present with nasal stuffiness, ear congestion, nasal bleeding, and hearing loss. Patients may also have palpable cervical lymph nodes.

Pathology

Histologically, there is follicular hyperplasia with an enlarged and irregular germinal center and thinning of the mantle zones. The germinal centers and mucosal surface may contain particles of HIV, HIV antigens, or markers for the RNA.

Treatment

There is no specific treatment for the adenoidal hypertrophy in HIV disease. The treatment is directed toward the disease itself.

Imaging Findings

CT