Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 19 , ISSUE 10 ( 2015 ) > List of Articles


A rare case of idiopathic cluster of differentiation 4 + T-cell lymphocytopenia presenting with disseminated tubercular infection

Vikas Sikri, Alok Jain

Keywords : Cryptococcal meningitis, disseminated tuberculosis, idiopathic cluster of differentiation 4 + T-cell lymphocytopenia, immunodeficiency, opportunistic infections

Citation Information : Sikri V, Jain A. A rare case of idiopathic cluster of differentiation 4 + T-cell lymphocytopenia presenting with disseminated tubercular infection. Indian J Crit Care Med 2015; 19 (10):621-623.

DOI: 10.4103/0972-5229.167054

License: CC BY-ND 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2015; The Author(s).


Idiopathic cluster of differentiation 4 + (CD4 +) T-cell lymphocytopenia is a rare heterogeneous clinical syndrome characterized by low absolute CD4 counts on two different occasions without any evidence of other known cause of immunodeficiency including human immunodeficiency virus (HIV), infections or drugs associated with fall in CD4 + count. Also referred to as severe unexplained HIV seronegative immune suppression by the World Health Organization, it was first described by Centers for Disease Control in 1992 in patients with opportunistic infections who were negative for HIV but had low CD4 counts. Patients typically present with opportunistic infections, malignancies, or autoimmune disorders. There have been case reports on opportunistic infections such as cryptococcal meningitis or non-Mycobacterium tuberculosis infections in these patients. However, no case of disseminated M. tuberculosis has been reported as such in Indian literature. We present a case of disseminated tuberculosis with low CD4 counts without any evidence of HIV infection.

PDF Share
  1. Centers for Disease Control (CDC). Unexplained CD4+T-lymphocyte depletion in persons without evident HIV infection: United States. MMWR Morb Mortal Wkly Rep 1992;41:541-5.
  2. Smith DK, Neal JJ, Holmberg SD. Unexplained opportunistic infections and CD4+T-lymphocytopenia without HIV infection. An investigation of cases in the United States. The centers for disease control idiopathic CD4+T-lymphocytopenia task force. N Engl J Med 1993;328:373-9.
  3. Zonios DI, Falloon J, Bennett JE, Shaw PA, Chaitt D, Baseler MW, et al. Idiopathic CD4+lymphocytopenia: Natural history and prognostic factors. Blood 2008;112:287-94.
  4. Ahmad DS, Esmadi M, Steinmann WC. Idiopathic CD4 lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases. Avicenna J Med 2013;3:37-47.
  5. Lee PI, Ciccone EJ, Read SW, Asher A, Pitts R, Douek DC, et al. Evidence for translocation of microbial products in patients with idiopathic CD4 lymphocytopenia. J Infect Dis 2009;199:1664-70.
  6. Thoden J, Venhoff N, Daskalakis M, Schmitt-Gräeff A, Dräger R, Schlesier M, et al. Disseminated tuberculosis in a patient with idiopathic CD4 lymphocytopenia. Rheumatology (Oxford) 2009;48:1329-30.
  7. Cunningham-Rundles C, Murray HW, Smith JP. Treatment of idiopathic CD4 T lymphocytopenia with IL-2. Clin Exp Immunol 1999;116:322-5.
  8. Trojan T, Collins R, Khan DA. Safety and efficacy of treatment using interleukin-2 in a patient with idiopathic CD4(+) lymphopenia and Mycobacterium avium-intracellulare. Clin Exp Immunol 2009;156:440-5.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.