Agyemang Emmanuel A, Makanga David M, Abdallah Malaz, Ogunnaya Frances, Forbes Shari
Internal Medicine, Newark Beth Israel Medical Center, Newark, USA.
Cureus. 2024 Mar 26;16(3):e56968. doi: 10.7759/cureus.56968. eCollection 2024 Mar.
Idiopathic CD4 lymphocytopenia (ICL) is a rare condition where CD4 T cell counts are low, similar to advanced human immunodeficiency virus (HIV) infection but without acquired immunodeficiency syndrome (AIDS)-related symptoms. The cause is unknown, and theories suggest issues with T cell production, survival, migration, or immune system dysregulation. Diagnosis involves ruling out other causes of low CD4 T cells. Treatment is based on managing infections and may include immunomodulatory therapies, but evidence is limited. Clinical presentations vary widely, including infections, autoimmune disorders, and malignancies. This study explores challenges in diagnosing persistent fevers and lymphopenia, the role of medical history in treatment, HIV screening issues, UTI management in recurrent cases, and the importance of follow-up care for unresolved symptoms or abnormal lab results. This study utilized a case study approach, focusing on the detailed presentation, evaluation, and management of the patient. Data were collected from the patient's medical records, including laboratory tests. Relevant literature was reviewed to provide context and support for the discussion of diagnostic challenges and management strategies. This case highlights the importance of considering uncommon presentations of common infections in patients with complex medical histories. It underscores the need for thorough evaluation, including comprehensive medical history, diagnostic testing, and follow-up care, to ensure accurate diagnosis and appropriate management. By sharing this case, we aim to enhance the awareness and understanding of such presentations among healthcare providers, leading to improved patient care and outcomes.
特发性CD4淋巴细胞减少症(ICL)是一种罕见病症,其CD4 T细胞计数较低,类似于晚期人类免疫缺陷病毒(HIV)感染,但没有获得性免疫缺陷综合征(AIDS)相关症状。病因不明,理论认为与T细胞产生、存活、迁移或免疫系统失调有关。诊断包括排除其他导致CD4 T细胞减少的原因。治疗基于控制感染,可能包括免疫调节疗法,但证据有限。临床表现差异很大,包括感染、自身免疫性疾病和恶性肿瘤。本研究探讨了诊断持续性发热和淋巴细胞减少症的挑战、病史在治疗中的作用、HIV筛查问题、复发性病例中尿路感染的管理以及对未解决症状或异常实验室结果进行随访护理的重要性。本研究采用了案例研究方法,重点关注患者的详细表现、评估和管理。数据从患者的病历中收集,包括实验室检查。查阅了相关文献,为讨论诊断挑战和管理策略提供背景和支持。该案例强调了在有复杂病史的患者中考虑常见感染不常见表现的重要性。它强调了进行全面评估的必要性,包括全面的病史、诊断测试和随访护理,以确保准确诊断和适当管理。通过分享这个案例,我们旨在提高医疗服务提供者对此类表现的认识和理解,从而改善患者护理和治疗结果。