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Infectious Disorders - Drug Targets

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ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

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Case Report

Disseminated Cryptococcosis in Idiopathic CD4+ Lymphocytopenia

Author(s): Ankita Dewangan, Jitendra Singh, Dinesh Kumar, Nilesh Kumar, Kailash Kumar and Anju Dinkar*

Volume 23, Issue 1, 2023

Published on: 17 August, 2022

Article ID: e210622206242 Pages: 4

DOI: 10.2174/1871526522666220621110723

Price: $65

Abstract

Introduction: Idiopathic CD4+ Lymphocytopenia (ICL) is a rare entity grouped in non– HIV-related syndromes. ICL is characterized by a marked low CD4 T cell count of <300 cells/mm3 with ambiguous natural history and prognosis. In addition, cryptococcal and nontuberculous mycobacterial infections are reported as known opportunistic infections. Therefore, management turns around vigilant follow-up and treatment of the current clinical scenario of these patients.

Case Presentation: Here, a 55-year-old lady was referred with a history of diffuse headache and intermittent fever for two months, projectile vomiting, and altered mental status for five days. Nonpruritic maculopapular rashes and diffuse desquamation of the skin were noted. She had no significant previous medical history. Based on clinical findings and investigations, she was diagnosed with ICL having disseminated cryptococcosis. Unfortunately, the patient did not undergo specific treatment as she was recognized late, and unfortunately, she died.

Conclusion: It is of paramount importance to recognize the clinical entity as early as possible to start appropriate treatment, which may positively impact the outcome. Therefore, the clinician must be aware of disseminated cryptococcosis associated with non-HIV states.

Keywords: Cryptococcal meningitis, ICL opportunistic infections, impaired immunity, immunocompetent, rare entity, non- HIV.

Graphical Abstract

[1]
Centers for Disease Control (CDC). Unexplained CD4+ T-lymphocyte depletion in persons without evident HIV infection-United States. MMWR Morb Mortal Wkly Rep 1992; 41(30): 541-5.
[PMID: 1353246]
[2]
Sharma A, Lal V, Modi M, Khurana D, Bal S, Prabhakar S. Idiopathic CD4 lymphocytopenia presenting as refractory cryptococcal meningitis. Ann Indian Acad Neurol 2010; 13(2): 136-8.
[http://dx.doi.org/10.4103/0972-2327.64646] [PMID: 20814499]
[3]
Dinkar A, Singh J, Atam V, Holla VV, Misra R, Kumar S. Disseminated cryptococcosis in an immune competent patient: An unusual case. Med Sci 2014; 15(60): 28-31.
[4]
Duncan RA, von Reyn CF, Alliegro GM, Toossi Z, Sugar AM, Levitz SM. Idiopathic CD4+ T-lymphocytopenia-four patients with opportunistic infections and no evidence of HIV infection. N Engl J Med 1993; 328(6): 393-8.
[http://dx.doi.org/10.1056/NEJM199302113280604] [PMID: 8093636]
[5]
Smith DK, Neal JJ, Holmberg SD. Unexplained opportunistic infections and CD4+ T-lymphocytopenia without HIV infection. An investigation of cases in the United States. The Centers for Disease Control Idiopathic CD4+ T-lymphocytopenia Task Force. N Engl J Med 1993; 328(6): 373-9.
[http://dx.doi.org/10.1056/NEJM199302113280601] [PMID: 8093633]
[6]
Yarmohammadi H, Cunningham-Rundles C. Idiopathic CD4 lymphocytopenia: Pathogenesis, etiologies, clinical presentations and treatment strategies. Ann Allergy Asthma Immunol 2017; 119(4): 374-8.
[http://dx.doi.org/10.1016/j.anai.2017.07.021] [PMID: 28958376]
[7]
Ayub MT, Jafar MS, Khalid M, Baig MA, Mba B. Suppressed without a cause: A case of idiopathic immune deficiency. cureus 2018; 10(1): e2009.
[http://dx.doi.org/10.7759/cureus.2009] [PMID: 29515938]
[8]
Ahmad DS, Esmadi M, Steinmann WC. Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases. Avicenna J Med 2013; 3(2): 37-47.
[http://dx.doi.org/10.4103/2231-0770.114121] [PMID: 23930241]
[9]
Longo F, Hébuterne X, Michiels JF, Maniere A, Caroli-Bosc FX, Rampal P. Multifocal MALT lymphoma and acute cytomegalovirus gastritis revealing CD4 lymphopenia without HIV infection. Gastroenterol Clin Biol 1999; 23(1): 132-6.
[PMID: 10219614]
[10]
Zonios D, Sheikh V, Sereti I. Idiopathic CD4 lymphocytopenia: A case of missing, wandering or ineffective T cells. Arthritis Res Ther 2012; 14(4): 222.
[http://dx.doi.org/10.1186/ar4027] [PMID: 22971990]
[11]
Ish P, Singh H, Anuradha S, Dewan R. Idiopathic CD4 lymphocytopenia presenting as cryptococcal meningitis. Astrocyte 2015; 2(1): 38-9.
[http://dx.doi.org/10.4103/2349-0977.168253]
[12]
Nair JP, Athavale AU, Gawande S, et al. Disseminated cryptococcosis with caverno-oesophageal fistula in a case of idiopathic CD4+ T-lymphocytopenia. J Assoc Physicians India 2014; 62(1): 66-9.
[PMID: 25327100]
[13]
Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis 2010; 50(3): 291-322.
[http://dx.doi.org/10.1086/649858] [PMID: 20047480]
[14]
Perfect JR, Marr KA, Walsh TJ, et al. Voriconazole treatment for less-common, emerging, or refractory fungal infections. Clin Infect Dis 2003; 36(9): 1122-31.
[http://dx.doi.org/10.1086/374557] [PMID: 12715306]

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