Idiopathic CD4+ lymphocytopenia in Hispanic male: case report and literature review

Abstract

IntroductionIdiopathic cluster of differentiation 4 (CD4+) T-cell lymphocytopenia (ICL) is a rare non human immunodeficiency virus (HIV)-related syndrome with unclear natural history and prognosis that was first reported and defined in 1992. ICL has been observed in patients after the onset of an opportunistic infection without known immunosuppression.Case presentationA 20-year-old Hispanic male patient without significant past medical history presented with progressive shortness of breath and cough for 3 weeks. Chest computed tomography showed bilateral cavitary lesions in the upper lung lobes. The HIV rapid screening test as well as the sputum acid-fast bacilli test were both positive. The patient was started on antituberculosis therapy. The CD4 count was noticed to be low. However, the HIV Western blot test was negative, and the HIV viral load was within normal limit. Further radiologic studies, hemato-oncologic, and autoimmune workups were normal. The patient was discharged on the treatment for tuberculosis. Follow-up after 8 weeks revealed a persistent low CD4+ count, and the repeated HIV tests were negative.ConclusionThe clinical features of ICL range from an asymptomatic condition to life-threatening complications that imitate the clinical course of HIV-infected patients. The differential diagnosis in adults comprises primarily HIV infection and other diseases or drug side effects. ICL is very rare and should be considered in the absence of any defined immunodeficiency or therapy associated with depressed levels of CD4+ T-cells. Early detection and recognition of the disease allow purposeful and systemic treatment approach and screening for the affected patients.

Pulmonary Cryptococcus infections as a manifestation of idiopathic CD4 lymphocytopenia: case report and literature review

“…In comparison, AIDS patients are most frequently infected with cytomegalovirus (33%) and PJP (29.9%), with only 2.6% cryptococcal infections [13, 14]. From a clinical perspective, the differences between the two diseases are relevant as ICL patients tend to have a progressive decline in CD4 counts, whereas AIDS patients exhibit a slower decline (or increase if antiretroviral medication is initiated) [8, 15].…”

CD4+ T lymphocytopenia associated with sideropenia: case report

“…Although a subgroup of patients remain asymptomatic, other patients may continue CD4+ T lymphocytopenia associated with sideropenia. to develop fatal opportunistic infections 3 or autoimmune diseases. 4 Increased levels of IgM (> 3X the normal range) were observed in the patient on 6 th April 2011.…”

Isolated cutaneous cryptococcosis in clinically unsuspected idiopathic CD4 lymphocytopenia

“…[5] Autoimmune diseases and chemotherapy drugs such as cyclophosphamide and methotrexate have also been found to be associated with CD4 lymphocytopenia with normal CD4:CD8 ratios. [6]…”