title: Idiopathic CD4+ T-lymphocytopenia: analysis of a patient with selective IgA deficiency and no evidence of HIV infection.
abstract: Idiopathic CD4+ T-lymphocytopenia (ICL) in HIV-seronegative patients is a newly described, rare entity. The common underlying abnormality is a usually stable depletion in CD4+ lymphocytes in patients, some of which have unexplained opportunistic infections. We present a previously unreported condition of an asymptomatic individual with CD4+ T-lymphocytopenia and a selective IgA deficiency. The subject is a 35-year-old healthy white male with a documented 5-year history of low CD4+ T cell counts. He has been repeatedly HIV seronegative and has no risk factors for HIV infection. Data were obtained from several laboratories over a 5-year period and include standard WBC differentials, HIV testing, serum immunoglobulin quantitation, mitogen stimulation assays, diphtheria and tetanus antitoxin titers, and flow cytometric immunophenotyping. The composite results show a subject with a normal white blood cell count, an absolute lymphopenia, a slight granulocytosis, and a selective IgA deficiency. Leukocyte subset analyses show essentially normal B but significantly altered T cell phenotypes. The normal CD4:CD8 ratio shows extreme inversion, primarily due to CD4 T-lymphocytopenia.
authors.affiliation: Department of Pathology, Henry Ford Hospital, Detroit, Michigan 48202, USA.
authors.forename: D
authors.initials: D
authors.lastname: Vertes
authors.forename: M D
authors.initials: MD
authors.lastname: Linden
authors.forename: J L
authors.initials: JL
authors.lastname: Carey
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D018023:HIV Seronegativity / Q000276:immunology*; D006801:Humans; D017098:IgA Deficiency / Q000276:immunology*; D008297:Male; D012307:Risk Factors; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000209:etiology*