Profound reduction of CD4+ lymphocytes without HIV infection: two cases from the horn of Africa

Je, Ollé-Goig; Ramírez, Juan Carlos Segoviano; Cervera, Carlos; Jm, Miró

doi:10.4314/ahs.v12i3.13

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…CD4 lymphocytopenia predisposes patients to opportunistic infections . The patients with CD4 lymphocytopenia in this study could not be diagnosed as idiopathic CD4 lymphocytopenia with only one testing.…”

Section: Discussionmentioning

confidence: 65%

A 6-year treatment experience for pemphigus: retrospective study of 69 Chinese patients

Bai

Li-ming

Xiao

et al. 2015

Dermatologic Therapy

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There is a lack of data on treatment and prognosis of pemphigus in China. The aim of this study was to evaluate long-term follow-up and prognosis of pemphigus. Forty-seven inpatients with pemphigus vulgaris (PV) and 22 with pemphigus foliaceus (PF) were recruited in this retrospective study. The average age at onset was 51.6 and 54.9 years in PV and PF, respectively. High-dose systemic steroids were administered in 47 PV and 21 PF, of which 18 PV and 8 PF with adjuvant therapies. CD4 lymphocytopenia was found in 5 PV and 2 PF patients at admission and successfully treated by intravenous thymopentin daily. During a mean follow-up of 37.1 months, 41 PV and 19 PF reached remission, 30 PV and 9 PF relapsed, 4 PV and 2 PF died. Major causes of death were relapse of pemphigus due to discontinuation of oral steroids by the patients themselves (four cases) and severe infections (two cases, one with severe CD4 lymphocytopenia). The 1-year mortality rate of PV and PF was 8.5% and 4.5%, respectively. Cox regression analysis indicated that age at onset of pemphigus was an independent risk factor related to the elevated mortality. Our report confirmed the high mortality rate of pemphigus in a Chinese population and stressed that patient education was urgently needed to prevent relapses and deaths.

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Section: Discussionmentioning

confidence: 65%

A 6-year treatment experience for pemphigus: retrospective study of 69 Chinese patients

Bai

Li-ming

Xiao

et al. 2015

Dermatologic Therapy

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“…The more prevalent autoimmune diseases described were Sjögren’s syndrome, sarcoidosis and psoriasis ( Ahmad et al , 2013 ; Baroudjian et al , 2014 ). Malignancies were reported in 17.7 % (53/300; 95 % CI 13.6–22.4 %) of ICL patients ( Ahmad et al , 2013 ; Ollé–Goig et al , 2012 ; Régent et al , 2014 ). The more prevalent malignancies cited were squamous and basal cell carcinoma of the skin, lymphomas, Kaposi’s sarcoma and Bowen’s disease.…”

Section: Reviewmentioning

confidence: 99%

Severe Pneumocystis jirovecii pneumonia in an idiopathic CD4+ lymphocytopenia patient: case report and review of the literature

et al. 2014

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Introduction:When diagnosing Pneumocystis jirovecii pneumonia (PJP), the clinical suspicion must be confirmed by laboratory tests. PJP is rarely described in patients with idiopathic CD4+ lymphocytopenia (ICL), a rare T-cell deficiency of unknown origin with persistently low levels of CD4+ T-cells (<300 µl−1 or <20 % of total lymphocytes) but repeated negative human immunodeficiency virus (HIV) tests. We retrospectively analysed a case of an ICL patient with severe PJP associated with multiple opportunistic infections (OIs). We also reviewed the literature since 1986.Case presentation:A laboratory-confirmed case of PJP associated with invasive candidiasis and cytomegalovirus infection was reported in an ICL patient. Despite early treatment, the patient died of respiratory failure under polymicrobial pneumonia. According to the literature, the mortality rate of ICL patients is 10.4 % (33/316). In ICL patients, the risk of OI is 83.2 % (263/316), with viral infections being the most prevalent (58.2 %, 184/316), followed by fungal infections (52.2 %, 165/316) and mycobacterial infections (15.5 %, 49/316). Dysimmunity is reported in 15.5 % (49/316) of ICL patients. Among the fungal infections, cryptococcal infections are the most prevalent (24.1 %, 76/316), followed by candidiasis (15.5 %, 49/316) and PJP (7.9 %, 25/316).Conclusions:The high risk of OIs underlines the importance of more vigorous preventative actions in hospitals. The response to therapy and the detection of early relapse of PJP may be monitored by several laboratory tests including quantitative PCR. It is essential to treat the ICL and to follow the guidelines concerning therapy and prophylaxis of OIs as given to HIV patients.

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“…One reason for this may be the small number of cases reported with p24 antigen positivity and CD4+ lymphocytopenia, without the presence of an HIV infection. Prior authors have labeled this phenomenon as "idiopathic CD4 lymphocytopenia" [6][7][8]. Others have documented CD4 reduction in cases of malaria, viral, bacterial, and parasitic infections, psychological stress, burns, malnutrition, corticosteroid use, overexercising, pregnancy, and normal variation [9].…”

Section: Introductionmentioning

confidence: 99%

HIV False-Positive Test in the Setting of CD4 Lymphocytopenia

Mohamed,

Hedriana,

Holbrook

et al. 2024

Cureus

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In 2016, we implemented a non-targeted Emergency Department (ED)-based HIV screening program at our academic medical center following revised CDC guidelines utilizing the Abbott Alinity 4th generation HIV-1/2 antigen (Ag)/antibody (Ab) immunoassay (Abbott Laboratories, Abbott Park, IL). Following the CDC algorithm, after reactive fourth-generation testing, HIV-1/2 Ab testing is conducted. Patients undergoing acute seroconversion (acutes) may express p24 Ag but have a negative confirmatory Ab test. Acutes have the same laboratory signature during the ED encounter as those that are false positive (False +), and the two patient groups are denoted as “equivocals” until viral load testing specifies a definitive HIV status. Among False + patients (Ab/Ag positive, Ab negative, viral load undetectable), there have been limited studies on those also demonstrating a reduction in CD4+ count, an uncommon phenomenon known as “idiopathic CD4 lymphocytopenia.” We review a patient with a reactive fourth-generation HIV Ab/p24 Ag test on two separate occasions. Despite lymphopenia with a reduced CD4 count, his symptoms resolved, and an RNA PCR test did not detect any presence of HIV (False +). This patient was unique as False + patient with p24 Ag reactive, as well as a coincidental low CD4 count in the absence of HIV infection. A low CD4 count is often a sign of significant HIV infection.

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Profound reduction of CD4+ lymphocytes without HIV infection: two cases from the horn of Africa

Cited by 5 publications

References 20 publications

A 6-year treatment experience for pemphigus: retrospective study of 69 Chinese patients

A 6-year treatment experience for pemphigus: retrospective study of 69 Chinese patients

Severe Pneumocystis jirovecii pneumonia in an idiopathic CD4+ lymphocytopenia patient: case report and review of the literature

HIV False-Positive Test in the Setting of CD4 Lymphocytopenia

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