DILS — SCE Infectious Diseases MCQ

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HardHIV MedicineDILSSCE Infectious Diseases

A 30-year-old man from Thailand presents with painless bilateral parotid swelling, generalised lymphadenopathy, and diffuse infiltrative lymphocytosis. He is found to be HIV positive with a CD4 count of 280 cells/µL. What is the most likely diagnosis?

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Correct answer: A — Diffuse infiltrative lymphocytosis syndrome (DILS) associated with HIV

Bilateral parotid enlargement with diffuse infiltrative lymphocytosis (predominantly CD8 T-cells) in an HIV-positive patient is characteristic of DILS (Diffuse Infiltrative Lymphocytosis Syndrome). It mimics Sjögren syndrome clinically but is driven by CD8 lymphocyte infiltration rather than autoantibody-mediated exocrinopathy. DILS can also cause sicca symptoms, pulmonary infiltrates, and peripheral neuropathy. Treatment is ART, which usually leads to improvement. It is distinct from HIV-associated salivary gland disease.

Reference: BHIVA 2022 – HIV-associated conditions; Lancet HIV 2020 – DILS review