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[Disseminated extrapulmonary tuberculosis in idiopathic CD4-lymphocytopenia]
1Innere Abteilung des St.-Josef-Hospitals, Oberhausen-Mitte.
Deutsche Medizinische Wochenschrift (1946)
|January 5, 1995
Summary
A previously healthy HIV-negative man developed severe extrapulmonary tuberculosis due to persistent CD4+ T-lymphocytopenia. This rare condition presented with fever and weight loss, highlighting a newly described syndrome.
Area of Science:
- Infectious Diseases
- Immunology
Background:
- Extrapulmonary tuberculosis (TB) can present insidiously in immunocompromised individuals.
- Understanding the immunological underpinnings of TB is crucial for diagnosing and managing atypical presentations.
Observation:
- A previously healthy 42-year-old male presented with unexplained septic fever, sweats, and weight loss.
- Initial investigations revealed elevated inflammatory markers (ESR, gamma-GT, alkaline phosphatase) but no clear infectious agent.
- Imaging suggested splenic and hepatic involvement, confirmed by biopsies showing granulomas and giant cells.
Findings:
- Biopsy and culture identified Mycobacterium tuberculosis, confirming disseminated, extrapulmonary TB without pulmonary involvement.
- The patient exhibited persistent CD4+ T-lymphocytopenia, identified as the cause of his severe TB.
- Treatment involved four-drug tuberculostatic therapy and glucocorticoids for fever control.
Implications:
- This case highlights a rare syndrome of extrapulmonary TB in an HIV-negative patient with CD4+ T-lymphocytopenia.
- It underscores the importance of considering TB in unexplained febrile illnesses, even without pulmonary signs.
- Further research is needed to elucidate the mechanisms behind this unexplained T-lymphocytopenia and associated TB susceptibility.