Watanabe H, Inukai A, Doyu M, Sobue G
Department of Neurology, Nagoya University School of Medicine.
Rinsho Shinkeigaku. 2000 Mar;40(3):249-53.
A 33-year-old Japanese man, with a history of recurrent skin cryptococcosis, was admitted complaining of fever and severe headache for 3 weeks. He had no known risk factors for human immunodeficiency virus (HIV) infection. Cerebrospinal fluid examination revealed an elevated opening pressure of 32 cm H2O, cell counts of 884/mm3, a total protein value of 184 mg/dl, a glucose level of 16 mg/dl, and demonstrated a positive India ink stain for fungus. Cultures grew Cryptococcus neoformans. Hematological studies showed a persistently low CD4+ cell count (30/mm3) and a low CD4/CD8 ratio of 0.1. He has been repeatedly seronegative (ELISA and Western blot) for HIV-1 and HIV-2. He responded to fluconazole, and was given itraconazole as secondary prophylaxis because of persistent low CD4 counts. To our knowledge this is the first patient with idiopathic CD4+ T lymphocytopenia associated with CNS cryptococcosis in Japan. CD4 counts should be part of the initial work up for patients with CNS cryptococcosis.
一名33岁的日本男性，有复发性皮肤隐球菌病病史，因发热和严重头痛3周入院。他没有已知的人类免疫缺陷病毒（HIV）感染风险因素。脑脊液检查显示初压升高至32 cm H2O，细胞计数为884/mm3，总蛋白值为184 mg/dl，葡萄糖水平为16 mg/dl，墨汁染色显示真菌阳性。培养物培养出新型隐球菌。血液学研究显示CD4+细胞计数持续偏低（30/mm3），CD4/CD8比值低至0.1。他的HIV-1和HIV-2多次血清学检测均为阴性（酶联免疫吸附测定和蛋白质印迹法）。他对氟康唑有反应，由于CD4计数持续偏低，给予伊曲康唑作为二级预防。据我们所知，这是日本首例与中枢神经系统隐球菌病相关的特发性CD4+T淋巴细胞减少症患者。对于中枢神经系统隐球菌病患者，CD4计数应作为初始检查的一部分。
