amphotericin-b and T-Lymphocytopenia--Idiopathic-CD4-Positive

Idiopathic CD4 lymphocytopenia (ICL) is a rare disease characterized by marked loss of CD4 T-cells without human immunodeficiency virus infection. CD4 T-cells play an important role in granuloma formation in cryptococcal infection. Thus far, among ICL patients, it has not been concluded definitely whether granuloma is formed or not. We report the case of a 39-year-old woman with ICL and disseminated cryptococcal infection with granuloma formation. She was referred to our department because of a lung mass, osteolytic lesion, and a subcutaneous mass identified on a computed tomography scan, and an elevated C-reactive protein level. Cryptococcus neoformans was isolated from the tissues. She also had marked CD4 lymphocytopenia (33 cells/μL), without human immunodeficiency virus infection. In a biopsy specimen of the lung mass, granulomas containing CD4 T-cells were observed. The cryptococcosis was treated with liposomal amphotericin B followed by fluconazole and she was found to be cured. The CD4 T-cell count was persistently low. This case showed that granulomas containing CD4 T-cells can be formed in ICL patients with cryptococcal infection despite very low CD4 T-cell counts.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; CD4 Lymphocyte Count; Cryptococcosis; Cryptococcus neoformans; Female; Fluconazole; Granuloma; Humans; Lung; Sjogren's Syndrome; T-Lymphocytopenia, Idiopathic CD4-Positive; Tomography, X-Ray Computed; Treatment Outcome

Idiopathic CD4 lymphocytopenia (ICL) is characterised by a low CD4 +lymphocyte count in the absence of HIV or other underlying aetiologies. We report a case of a 17-year-old girl with ICL with autoimmune hepatitis who developed isolated renal mucormycosis, which, to our knowledge, is the first reported case described in literature. Combination therapy with antifungals and surgical resection was done, and the patient improved. This case report illustrates the importance of timely multidisciplinary approach to recognise this highly fatal disease at an early stage.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Diagnosis, Differential; Female; Humans; Kidney; Kidney Diseases; Mucormycosis; T-Lymphocytopenia, Idiopathic CD4-Positive; Triazoles

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Humans; Leishmaniasis, Visceral; Male; Middle Aged; Pentamidine; T-Lymphocytopenia, Idiopathic CD4-Positive

An adolescent with idiopathic CD4 lymphocytopenia suffered from 4 visceral leishmaniasis relapses despite appropriate treatment. CD8 lymphocytopenia and abnormal expansion of TCRalphabeta, CD4, CD8 cells were consistently detected together with reduced export of mature T cells from thymus. This novel form of idiopathic CD4 lymphocytopenia may predispose to multiple visceral leishmaniasis relapses.

Topics: Adolescent; Allopurinol; Amphotericin B; Antipruritics; Female; Humans; Immunophenotyping; Keratins; Leishmaniasis, Visceral; Lymph Nodes; Recurrence; T-Lymphocytopenia, Idiopathic CD4-Positive

Topics: Adult; Amphotericin B; Cryptococcosis; Fatal Outcome; Fluconazole; Humans; Immunocompromised Host; Male; T-Lymphocytopenia, Idiopathic CD4-Positive; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a Malay girl with disseminated cryptococcosis affecting the lungs, liver, lymph nodes and bones. The diagnosis was made by culture of the bone marrow. Tests of immune function showed that she was HIV-negative but the CD4 percentage was persistently low. Idiopathic CD4+ T-lymphocytopenia was diagnosed. The child died despite two courses of anti-fungal therapy.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Bone Marrow; Child, Preschool; Cryptococcosis; Drug Therapy, Combination; Fatal Outcome; Female; Fluconazole; Flucytosine; Humans; Liver; Lung; Lymph Nodes; T-Lymphocytopenia, Idiopathic CD4-Positive