Nair Jairaj P, Athavale Amita U, Gawande Sonal, Shah Unmil, Baldi Milind, Gupt Vishal, Gavali Varun
J Assoc Physicians India. 2014 Jan;62(1):66-9.
Idiopathic CD4+ T-Lymphocytopenia is a rare immunodeficiency disorder characterised by significantly low absolute CD4 lymphocytes in absence of any viral infections. We present a case of Disseminated Cryptococcosis with Caverno- Oesophageal Fistula in a case of Idiopathic CD4+ T-Lymphocytopenia. 29 year old lady was referred to Institute in view of lung mass not responding to anti-TB treatment. Subsequently patient had developed headache. Radiological evaluation showed presence of ring enhancing lesion in the occipital region. On evaluation with Fibre-optic bronchoscopy, there was no evidence of malignancy or tuberculosis. Sputum showed presence and growth of Cryptococcus neoformans. Patient's investigations were negative for virus infection, with normal immunoglobulin levels. Her CD4 counts were 129 cells/mm3. Patient was treated with injectable antifungals. Patient developed a Caverno-oesophageal fistula which was confirmed on endoscopy and radiology. Patient was managed with percutaneous jejunal feeding (PEJ). Patient improved symptomatically with CD4 count of 475 cells/mm3.
特发性CD4⁺T淋巴细胞减少症是一种罕见的免疫缺陷疾病，其特征是在没有任何病毒感染的情况下，绝对CD4淋巴细胞显著减少。我们报告一例特发性CD4⁺T淋巴细胞减少症患者发生播散性隐球菌病并伴有 cavern - 食管瘘。一名29岁女性因肺部肿块对抗结核治疗无反应而被转诊至我院。随后患者出现头痛。影像学评估显示枕部有环形强化病灶。经纤维支气管镜检查，未发现恶性肿瘤或结核证据。痰标本显示新型隐球菌存在并生长。患者病毒感染检查为阴性，免疫球蛋白水平正常。她的CD4细胞计数为129个/立方毫米。患者接受了注射用抗真菌药物治疗。患者出现了cavern - 食管瘘，经内镜和影像学检查得以证实。患者接受了经皮空肠造瘘喂养（PEJ）治疗。患者症状改善，CD4细胞计数达到475个/立方毫米。
