Cutaneous infections by papillomavirus, herpes zoster and Candida albicans as the only manifestation of idiopathic CD4+ T lymphocytopenia.
BACKGROUND
Selective depletion of CD4+ T lymphocytes is common in both primary and secondary immunodeficiencies. Idiopathic CD4+ T lymphocytopenia (ICL) cases are defined as a persistent CD4+ T lymphocyte count of less than 300x10(6) cells/L and/or less than 20% of the total T-cell count.


METHODS
A 40-year-old woman, with a history of psoriasis and paracetamol allergy, presented with persistent warts of the hands and condylomas of the ano-genitalia. Histological and virological analysis was carried out on genital and cutaneous lesions and peripheral blood.


RESULTS
Serology for HIV-1, HIV-2, Epstein-Barr virus and parvovirus B19 were negative. There was lymphopenia of 10% CD4+ cells, with normal numbers of total leukocytes; there were no other-abnormal immunological findings. DNA analysis of cutaneous lesions revealed HPV-49 and HPV-3 in the hands and HPV-6 in the genital region.


CONCLUSIONS
The cause of the ICL in this patient is unknown. HPV is not known to be an immunosuppressive agent; it remains to be determined whether the HPV-associated lesions are the cause or the result of immunosuppression.
Manchado Lopez
P
P
Dermatology Service and the Immunology Unit, Hospital de León, Spain.
Ruiz de Morales
J M
JM
Ruiz González
I
I
Rodriguez Prieto
M A
MA
D000328:Adult; D002177:Candidiasis / Q000150:complications*; D005260:Female; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D018655:Lymphocyte Count; D030361:Papillomavirus Infections / Q000150:complications*; D012874:Skin Diseases, Infectious / Q000209:etiology / Q000473:pathology*; D016176:T-Lymphocyte Subsets / Q000166:cytology; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000150:complications / Q000473:pathology*; D014412:Tumor Virus Infections / Q000150:complications*