Recurrent respiratory infections and gastroenteritis associated with failure to thrive in a 17-month-old infant

Our patient's clinical/immunologic course was consistent with an acquired immunodeficiency syndrome (AIDS) of infancy. The pertinent risk factors present include a maternal history of multiple sexual partners and intravenous drug abuse before and during pregnancy. As in the adult form, an initial prodromal phase is followed by a progressive severe immunodeficiency, and ultimately by opportunistic infections. Common clinical features of AIDS in children include low birth weight, failure to thrive, generalized lymphadenopathy, hepatosplenomegaly, parotitis, chronic diarrhea, recurrent bacterial and viral infections, and oropharyngeal thrush. Opportunistic infections with pneumocystis carinii, mycobacterium avium intracellularae, and CMV follow later on. In our experience, pulmonary disease is a prominent early feature. It can present as recurrent lobar, alveolar infiltrates, responsive to intravenous antibiotics such as ampicillin. Later on, chronic bilateral interstitial infiltrates develop and are associated with progressive hypoxemia and digital clubbing. Lung biopsy has documented the presence of a nodular and/or diffuse lymphotic infiltration in many of these patients. Others have presented with acute respiratory distress from pneumonitis with P. carinii and disseminated CMV.