Yonsei Med J.  2005 Feb;46(1):173-176. 10.3349/ymj.2005.46.1.173.

A Case of Pulmonary Cryptococcosis with Non-Small Cell Lung Cancer in Idiopathic CD4+ T-Lymphocytopenia

• Ahn IS
• Kim HG
• Ryu JS
• Kim L
• Kwak SM
• Lee HL
• Yoon YH
• Cho JH

• KMID: 2158131
• DOI: http://doi.org/10.3349/ymj.2005.46.1.173

Abstract

Cryptococcus neoformans commonly causes opportunistic infections in immunocompromised patients, especially in patients with AIDS. CD4+ T-lymphocytopenia in AIDS indicates an increased risk of opportunistic infection and a decline in immunological function. Idiopathic CD4 T-lymphocytopenia (ICL) is characterized by depletions in the CD4+ T-cell subsets, without evidence of HIV infection. Immunodeficiency can exist in the absence of laboratory evidence of HIV infection, and T-cell subsets should be evaluated in patients who present with unusual opportunistic infections. We report a case of pulmonary cryptococcosis and lung cancer in a patient with persistently low CD4+ cell counts, without evidence of HIV infection.

Keyword

Idiopathic CD4 T-lymphocytopenia; cryptococcosis; lung cancer

MeSH Terms

Aged
CD4 Lymphocyte Count
CD4-Positive T-Lymphocytes/*pathology
Carcinoma, Non-Small-Cell Lung/*complications/immunology
Cryptococcosis/*complications/immunology
Humans
Lung Neoplasms/*complications/immunology
Lymphopenia/*complications/immunology
Male

Figure

• 

  Fig. 1 Chest PA showed multiple patch consolidations and thick-walled cavitary lesions, with nodules in both lung fields.

• 

  Fig. 2 Chest CT scan showed multiple patch consolidations, nodules with cavity formations, and severe wall thickening of subsegmental bronchi in both lung fields.

• 

  Fig. 3 Histologic findings were yeast-form fungi, consistent with cryptococci (H&E, × 200).

Reference

1. Centers for Disease Control and Prevention. Unexplained CD4+ T lymphocyte depletion in persons without evident HIV infection. MMWR. 1992. 41:541–545.

2. Smith DK, Neal JJ, Holmberg DS. Unexplained opportunistic infections and CD4+ T lymphocytopenia without HIV infection. N Engl J Med. 1993. 328:373–379.

3. Laurence J, Mitra D, Steiner M, Lynch DH, Siegal FP, Staiano-Coico L. Apoptotic depletion of CD4+ T cells in idiopathic CD4+ T lymphocytopenia. J Clin Invest. 1996. 97:672–680.

4. Uehara T, Miyawaki T, Ohta K, Tamaru Y, Yokoi T, Nakamura S, et al. Apoptotic cell death of primed CD45RO+ T lymphocytes in Epstein-Barr virus-induced infectious mononucleosis. Blood. 1992. 80:452–458.

5. Fauci AS. CD4 T-lymphocytopenia without HIV infection. no lights, no camera, just facts. N Engl J Med. 1993. 328:429–431.

6. Yinnon AM, Rudensky B, Sagi E, Breuer G, Brautbar C, Polacheck I, et al. Invasive cryptococcosis in a family with epidermodysplasia verruciformis and idiopathic CD4 cell depletion. Clin Infect Dis. 1997. 25:1252–1253.

7. Menon BS, Shuaib IL, Zamari M, Haq JA, Aiyar S, Noh LM. Idiopathic CD4+ T-lymphocytopenia in a child with disseminated cryptococcosis. Ann Trop Pediatr. 1998. 18:45–48.

8. Chuck SL, Sande MA. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. N Engl J Med. 1989. 321:794–799.

9. 1999 USPHS/IDSA guideline for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep. 1999. 48:1–65.

10. Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, et al. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin Infect Dis. 2001. 33:690–699.