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 immunosuppressive
drugs, and in patients with idiopathic CD-4 lymphocytopenia. The mechanism
for the lymphocytopenia is different in each of these illnesses.
Objective: Description of HIV-negative patients with severe disseminated tuberculosis or
coccidioidomycosis and lymphocytopenia.
Settings and patients: All patients were referred to a University Medical Center in Northwest
Texas, USA. Four had disseminated tuberculosis, and three had disseminated coccidioidomycosis.
Main outcome measures: Follow-up of lymphocyte subset counts and clinical improvement
with the treatment of the underlying granulomatous infection.
Results: Five patients had an increase in both CD-4 and CD-8 lymphocyte subset counts
with treatment of the underlying granulomatous infection. All patients had clinical improvement
with initial therapy of the granulomatous infection. One patient succumbed to disseminated
tuberculosis (meningitis) and two to disseminated coccidioidomycosis. One patient
was lost to follow up.
Conclusions: We report a group of HIV-negative patients who had CD-4 lymphocytopenia
in response to severe, disseminated, chronic granulomatous infections. With the treatment
of the granulomatous infection the lymphocytopenia improved. This finding, coupled
with preserved CD-4/CD-8 ratios, can help to differentiate these patients from those with
other causes of lymphocytopenia or AIDS.