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Abstract
Idiopathic CD4+ T-lymphocytopenia (ICL) is defined by the CDC as depressed numbers of circulating CD4+ T-lymphocytes (＜300 cells/μL or ＜20% of the total T cells) on more than one determination, with the absence of HIV infection and other known causes of immunodeficiency. The clinical spectrum of ICL ranges from asymptomatic laboratory abnormalities to severe opportunistic infections that mimic the clinical course of human immunodeficiency virus (HIV) infected patients. There are a few reports of ICL associated with different diseases such as Sjogren's syndrome, pulmonary sarcoidosis, Down syndrome or non-Hodgkin's lymphoma. We describe here a 5-year-old male patient with a three-year history of recurrent otitis media and pulmonary infection, and he was without any risk factors for HIV infection; this patient presented with autoimmune hemolytic anemia and was ultimately found to have idiopathic CD4+ T-lymphocytopenia.
REFERENCES
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Fig. 1
The peripheral blood smear showed severe anemia with RBC agglutination, polychromasia, spherocytes, and normoblasts (Wright stain, ×1,000)
Table 1.
Past medical history for this patient
Table 2.
The results of antibody screening test and Direct Coombs’ test
| Age (years/months) | Antibody screening | Direct Coombs’ test | |||
|---|---|---|---|---|---|
| Selectogen I | Selectogen II | IgG | C3d | Auto contro | |
| 5/3∗ | 4+ | 4+ | 4+ | - | 4+ |
Table 3.
The results of immunoglobulin quantitation test and complement test
| Age (years/months) | IgG mg/dL | IgA mg/dL | IgM mg/dL | IgD mg/dL | IgE IU/mL | C3 mg/dL | C4 mg/dL | CH50 U/mL |
|---|---|---|---|---|---|---|---|---|
| 3/6 | 1,681 | 59 | 149 | NT | NT | 125 | 22 | 18.6 |
| Reference ranges∗ | 400～1,250 | 24～192 | 41～200 | 0～14 | 0.0～29.2 | 70～150 | 10～30 | 23～46 |
| 5/3† | 2,108 | 63 | 162 | 2.1 | 1.5 | 106 | 19 | 31.7 |
| Reference ranges∗ | 560～1,307 | 26～232 | 47～200 | 0～14 | 0.2～17.6 | 70～150 | 10～30 | 23～46 |
Table 4.
The results of lymphocyte subset test
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