[A case of cryptococcal meningitis in an HTLV-1 carrier]

We report a case of 73-year-old male HTLV-I carrier with cryptococcal meningitis. The patient, who was born in Taiwan, has raised golden pheasants for ten years and bantams for five years. Antibody to HIV was negative. Flow cytometric study of the peripheral lymphocytes showed reduced CD4+CD45RA+ (naive cells) and increased CD4+CD45RO+ (memory cells), CD3+CD25+ and CD3+ HLA-DR(DR)+ cells. Lymphocyte responses to phytohemagglutinin and concanavalin A were depressed. Cerebrospinal fluid (CSF) cells and serum and CSF antigen to cryptococcal neoformans were decreased by therapy with fluconazole and flucytosine. Although the naive, memory and CD3+DR+ cell abnormalities showed no change, the CD45RA/CD45RO ratio and CD3+CD25+ level tended to improve. Opportunistic infections such as cryptococcal meningitis may be induced by severe decreases in naive cells and increases in memory cells in HTLV-I carriers.