Idiopathic CD4+ T-lymphocytopenia--a diagnostic dilemma

The devastating global impact of acquired immunodeficiency syndrome (AIDS) has greatly sensitized the public to the threat of new microbes that are capable of wrecking havoc on the world's population. The HIV virus infects and depletes CD4+ T lymphocytes. However cases have been described with profound CD4+ T cell lymphocytopenia but without evidence of HIV infection, a condition now termed as "Idiopathic CD4+ T-Lymphocytopenia". This unexpected revelation at the Ninth International AIDS Conference in Amsterdam was a cause of great public concern and extra ordinary media attention. Hence the Centre for Disease Control and Prevention in Atlanta (CDC) reviewed 23179 cases in the CDC AIDS reporting registry and performed interviews medical record reviews and laboratory analysis of blood specimens and finally identified 47 cases that met the CDC case definition of idiopathic CD4+ T cell lymphocytopenia (<300 CD4+Tcells/cumm or a CD4+ cell count <20% of the total T cell on two occasions, no evidence of infection on HIV testing, absence of any defined immunodeficiency or therapy associated with depressed levels of CD4+ T cells). We are hereby reporting one such case we encountered at our centre who presented with monoparesis and subsequently developed multiple cranial nerve palsy and deteriorating sensorium unresponsive to therapy which eventually turned out to be a case of "Idiopathic CD4+ T-Lymphocytopenia" with cryptococcal meningitis.