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Two cases of idiopathic CD4+ T-lymphocytopenia in elderly patients
W Matsuyama1, T Tsurukawa, F Iwami
1Department of Respiratory Medicine, National Minami-kyushu Hospital, Kagoshima.
Insights
Idiopathic CD4+ T-lymphocytopenia (ICL) is presented in two elderly pneumonia patients. This condition, characterized by low CD4+ T-cells without HIV, may be an underdiagnosed cause of severe pneumonia in older adults.
Area of Science:
- Immunology
- Geriatrics
- Infectious Diseases
Background:
- Idiopathic CD4+ T-lymphocytopenia (ICL) is a rare condition characterized by a persistent decrease in CD4+ T-lymphocyte counts without evidence of human immunodeficiency virus (HIV) infection.
- ICL can lead to opportunistic infections and increased susceptibility to various illnesses, particularly in immunocompromised individuals.
Observation:
- Two elderly male patients, aged 73 and 72, presented with severe pneumonia and significantly low CD4+ T-lymphocyte counts (109/microl and 238/microl, respectively).
- Neither patient showed signs of HIV infection. Case 1 involved Pneumocystis carinii pneumonia and resulted in death from respiratory failure despite treatment. Case 2, with Hemophilus influenzae pneumonia, improved with antibiotic therapy.
Findings:
- The cases highlight a potential association between ICL and severe pneumonia in the elderly population.
- The diagnostic workup for severe pneumonia in elderly patients should consider ICL as a differential diagnosis, especially when HIV is excluded.
Implications:
- ICL may be an underrecognized contributor to severe pneumonia and mortality in elderly individuals.
- Early recognition and management of ICL in this demographic could potentially improve patient outcomes and reduce morbidity.
- Further research is warranted to elucidate the prevalence and specific mechanisms of ICL in elderly patients presenting with pneumonia.
Abstract:
We present 2 cases of idiopathic CD4+ T-lymphocytopenia (ICL) in elderly patients. Case 1, a 73-year-old man, with pneumonia had received several antibiotics with unsuccessful results at another hospital. On admission, his CD4+ T-lymphocyte count was 109/microl and Pneumocystis carinii was detected by bronchoalveolar lavage fluid staining. No evidence of human immunodeficiency virus (HIV) infection was found. Despite therapy, the patient died of respiratory failure. Case 2, a 72-year-old man, contracted severe pneumonia, and Hemophillus influenzae was believed to be the pathogen. On admission, his CD4+ T-lymphocyte count was 238/microl. No evidence of HIV infection was found. He received antibiotics and improved successfully. We suggest that ICL may currently be incubating in a number of elderly pneumonia patients.