Siderits Richard H, Ouattara Osman, Marcus Alan, Gao Hong Guang, Deng Hong Bing, Godyn Janusz
Robert Wood Johnson University Hospital Hamilton, New Brunswick, USA.
Cytojournal. 2010 Aug 5;7:13. doi: 10.4103/1742-6413.67106.
Idiopathic CD4+ lymphocytopenia, described in 1992 by the Centers for Disease Control, is characterized by persistent CD4+ lymphocytopenia (less than 300 cells per micro-liter) in nonimmunosuppressed, HIV negative individuals, who present with atypical infections. This rare though likely undiagnosed entity is associated with chronic disseminated forms of either fungal or bacterial infections in otherwise healthy adults. We report a case of a 59-year-old male with ring-enhancing brain lesions, bilateral adrenal masses, lung and vocal cord nodules, where the diagnosis of exclusion was metastatic malignancy. Fine needle aspiration (FNA) of the adrenal mass and a subsequent vocal cord biopsy confirmed chronic widely disseminated blastomycosis. Flow cytometric evaluation of peripheral blood documented persistent selective CD4+ lymphocytopenia with T8 (suppressor) T-Lymphocyte count within normal range. We believe that idiopathic CD4+ lymphocytopenia is an important etiologic factor to be considered for patients who present with mass lesions and are diagnosed by FNA with atypical fungal infections. We relate the diagnostic criteria for idiopathic CD4+ lymphocytopenia and the importance of providing on-site triage for FNA samples for fungal studies and correlation for flow cytometry.
特发性CD4+淋巴细胞减少症于1992年由疾病控制中心描述，其特征是在无免疫抑制、HIV阴性且出现非典型感染的个体中持续存在CD4+淋巴细胞减少（每微升少于300个细胞）。这种罕见但可能未被诊断出的病症与原本健康的成年人中真菌或细菌感染的慢性播散形式有关。我们报告一例59岁男性病例，其脑部有环形强化病变、双侧肾上腺肿块、肺部和声带结节，排除诊断为转移性恶性肿瘤。肾上腺肿块的细针穿刺活检（FNA）及随后的声带活检证实为慢性广泛播散性芽生菌病。外周血的流式细胞术评估显示持续存在选择性CD4+淋巴细胞减少，T8（抑制性）T淋巴细胞计数在正常范围内。我们认为，对于出现肿块病变并通过FNA诊断为非典型真菌感染的患者，特发性CD4+淋巴细胞减少症是一个需要考虑的重要病因。我们阐述了特发性CD4+淋巴细胞减少症的诊断标准以及为真菌研究提供FNA样本现场分类和流式细胞术相关性的重要性。
