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Disseminated cryptococcosis with granuloma formation in idiopathic CD4 lymphocytopenia

Hayato Shimizu1, Shigeo Hara2, Hiroaki Nishioka1

  • 1Department of General Internal Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|July 27, 2019
PubMed

Insights

Idiopathic CD4 lymphocytopenia (ICL) is a rare condition. This case demonstrates that granulomas with CD4 T-cells can form in ICL patients with cryptococcal infections.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Rare Diseases

Background:

  • Idiopathic CD4 lymphocytopenia (ICL) is a rare condition characterized by a significant decrease in CD4 T-cells without HIV infection.
  • CD4 T-cells are crucial for forming granulomas during cryptococcal infections.
  • The ability of ICL patients to form granulomas has been uncertain.

Observation:

  • A 39-year-old woman with ICL presented with disseminated cryptococcal infection.
  • She had a lung mass, osteolytic lesion, and subcutaneous mass, along with elevated C-reactive protein.
  • Biopsy revealed granulomas containing CD4 T-cells within the lung mass.

Findings:

  • The patient had severe CD4 lymphocytopenia (33 cells/μL) but no HIV infection.
  • Cryptococcus neoformans was identified as the causative agent.
  • Granuloma formation, including CD4 T-cells, was observed despite profound lymphocytopenia.

Implications:

  • This case confirms that granulomas containing CD4 T-cells can form in ICL patients with cryptococcal infections.
  • It highlights the complex interplay between CD4 T-cell counts and immune responses in rare diseases.
  • Understanding granuloma formation in ICL is vital for managing opportunistic infections.

Keywords:
CryptococcusGranulomaIdiopathic CD4 lymphocytopeniaSjögren syndrome

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