Safety and efficacy of treatment using interleukin-2 in a patient with idiopathic CD4(+) lymphopenia and Mycobacterium avium-intracellulare.
We present the case of a 39-year-old white man with a Myobacterium avium-intracellulare pulmonary infection found to have a CD4(+) count of 172 cells/mm(3) and diagnosed subsequently with idiopathic CD4(+) lymphopenia (ICL). After receiving clathromycin for 4 months with minimal improvement, the patient was started on pegylated subcutaneous interleukin (IL)-2 at 600,000 units daily. Later, he received incrementally higher pegylated IL-2 doses until he reached a maintenance dose 3 months later of 11 million units weekly divided into three equal doses. After 5 months of therapy, the patient's chronic cough resolved completely, sputum cultures became negative for Myobacterium avium-intracellulare and the CD4(+) T cell count increased to 553 cells/mm(3). After 35 months of well-tolerated IL-2 treatments and no recurrence of any opportunistic infections, IL-2 treatment was stopped. CD4(+) counts 6 and 9 months after discontinuing IL-2 treatment were 596 and 378 cells/mm(3) respectively, and he remains asymptomatic. This report supports IL-2 treatment for ICL-associated opportunistic infections as a safe and potentially efficacious treatment option, especially when combined with more traditional treatment regimens.
Department of Internal Medicine, University of Texas Southwestern Medical Allergy and Immunology, Dallas, TX 75390, USA. ttroja@parknet.pmh.org
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D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D006801:Humans; D007376:Interleukin-2 / Q000627:therapeutic use*; D008231:Lymphopenia / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D009894:Opportunistic Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology
D007376:Interleukin-2