CD-4/CD-8 lymphocytopenia in HIV negative patients with severe, chronic granulomatous infections

Abstract

Background: CD-4 lymphocytopenia can occur in acquired immunodeficiency syndrome(AIDS), in severe combined immunodeficiency, with the use of corticosteroids and/or immunosuppressivedrugs, and in patients with idiopathic CD-4 lymphocytopenia. The mechanismfor the lymphocytopenia is different in each of these illnesses.Objective: Description of HIV-negative patients with severe disseminated tuberculosis orcoccidioidomycosis and lymphocytopenia.Settings and patients: All patients were referred to a University Medical Center in NorthwestTexas, USA. Four had disseminated tuberculosis, and three had disseminated coccidioidomycosis.Main outcome measures: Follow-up of lymphocyte subset counts and clinical improvementwith the treatment of the underlying granulomatous infection.Results: Five patients had an increase in both CD-4 and CD-8 lymphocyte subset countswith treatment of the underlying granulomatous infection. All patients had clinical improvementwith initial therapy of the granulomatous infection. One patient succumbed to disseminatedtuberculosis (meningitis) and two to disseminated coccidioidomycosis. One patientwas lost to follow up.Conclusions: We report a group of HIV-negative patients who had CD-4 lymphocytopeniain response to severe, disseminated, chronic granulomatous infections. With the treatmentof the granulomatous infection the lymphocytopenia improved. This finding, coupledwith preserved CD-4/CD-8 ratios, can help to differentiate these patients from those withother causes of lymphocytopenia or AIDS.