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

Ahn, In-Seon; Kim, Hee-gu; Ryu, Jeong‐Seon; Kim, Lucia; Kwak, Sang Mi; Lee, Hong-Lyeol; Yoon, Yong-Hwan; Cho, Jae Hwa

doi:10.3349/ymj.2005.46.1.173

Cited by 18 publications

(13 citation statements)

References 9 publications

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“…Only English language papers were reviewed. We found 258 cases diagnosed with ICL in 143 published papers[134567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980818283848586878889909192939495969798…”

Section: Methodsmentioning

confidence: 99%

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

2013

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Idiopathic CD4 lymphocytopenia (ICL) was first defined in 1992 by the US Centers for Disease Control and Prevention (CDC) as the repeated presence of a CD4+ T lymphocyte count of fewer than 300 cells per cubic millimeter or of less than 20% of total T cells with no evidence of human immunodeficiency virus (HIV) infection and no condition that might cause depressed CD4 counts. Most of our knowledge about ICL comes from scattered case reports. The aim of this study was to collect comprehensive data from the previously published cases to understand the characteristics of this rare condition. We searched the PubMed database and Science Direct for case reports since 1989 for Idiopathic CD4 lymphocytopenia cases. We found 258 cases diagnosed with ICL in 143 published papers. We collected data about age, sex, pathogens, site of infections, CD4 count, CD8 count, CD4:CD8 ratio, presence of HIV risk factors, malignancies, autoimmune diseases and whether the patients survived or died. The mean age at diagnosis of first opportunistic infection (or ICL if no opportunistic infection reported) was 40.7 ± 19.2 years (standard deviation), with a range of 1 to 85. One-sixty (62%) patients were males, 91 (35.2%) were females, and 7 (2.7%) patients were not identified whether males or females. Risk factors for HIV were documented in 36 (13.9%) patients. The mean initial CD4 count was 142.6 ± 103.9/mm3 (standard deviation). The mean initial CD8 count was 295 ± 273.6/mm3 (standard deviation). The mean initial CD4:CD8 ratio was 0.6 ± 0.7 (standard deviation). The mean lowest CD4 count was 115.4 ± 87.1/mm3 (standard deviation). The majority of patients 226 (87.6%) had at least one infection. Cryptococcal infections were the most prevalent infections in ICL patients (26.6%), followed by mycobacterial infections (17%), candidal infections (16.2%), and VZV infections (13.1%). Malignancies were reported in 47 (18.1%) patients. Autoimmune diseases were reported in 37 (14.2%) patients.

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Section: Methodsmentioning

confidence: 99%

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

2013

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“…Our patient denied an exposure history of bird secretions, dust and pollen. Previous studies have reported that T-cell-mediated immune dysfunction often occurs in patients with cancer after chemotherapy, who are susceptible to pulmonary cryptococcosis [4,5]. We believe that surgery for such patients is a more appropriate choice, at least in some cases, which could also help attain correct diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 93%

Solitary pulmonary mass in a patient with a history of lymphoma: a case report

Yuan

Shen

et al. 2013

J Med Case Reports

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IntroductionWith the progress made in treatments, the survival rate for patients with malignant lymphoma in the last 30 years has significantly improved. However, the risk of experiencing a second primary malignancy or other disease has increased significantly.Case presentationA 44-year-old Mongolian man with a large mass in his right lower abdomen was admitted to our hospital 15 years previously. The mass was removed, and confirmed via pathological examination to be a malignant B-cell lymphoma in the appendix and distal small bowel. Post-operative chemotherapy with standard cyclophosphamide, hydroxydaunomycin, vincristine (Oncovin®) and prednisolone regimen was given for six cycles. No obvious recurrence was detected over the following 12 years. Subsequently, a mass in the right lung was found on a regular X-ray follow-up; our patient did not report chills, fever or cough. Chest computed tomography and positron emission tomography scans confirmed the mass. A primary lung carcinoma was considered to be the most likely diagnosis. However, after an exploratory thoracotomy and right upper lobectomy was performed a pathological examination of tissue samples demonstrated a lung cryptococcal granuloma, with positive staining for periodic acid Schiff and periodic acid-silver metheramine.ConclusionsCompared to the normal population, second primary malignancy (in particular leukaemia and lung cancer) in patients with malignant lymphoma during their long-term survival has been seen occasionally. However, other diagnoses should also be considered such as pulmonary cryptococcosis. Other than computed-tomography-guided needle biopsy, surgery for some patients is a much more appropriate choice, which could also help attain correct diagnosis and treatment.

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“…We believe that the condition of our patient meets the diagnostic criteria for ICL as he had no evidence of HIV infection and had never received immunosuppressive drugs and his CD4+ T-lymphocyte count was below 300 cells/mm 3 during the long follow-up period. Further, [8][9][10]. Still, the optimal treatment and prophylaxis for OIs in patients with ICL remain to be defined.…”

Section: Discussionmentioning

confidence: 99%

Multiple Opportunistic Infections and Primary Central Nervous System Lymphoma in a Patient with Idiopathic CD4+ T-lymphocytopenia

et al. 2012

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We describe a case of idiopathic CD4+ T-lymphocytopenia (ICL) in a 59-yearold patient who presented with various opportunistic infections. The patient was diagnosed with disseminated Mycobacterium avium infection, cytomegalovirus colitis and retinitis, and esophageal candidiasis. He was successfully treated with anti-mycobacterial drugs, ganciclovir, and fluconazole, respectively. However, the patient was diagnosed with primary central nervous system lymphoma, and then died of a Trichosporon beigelii sepsis during the 2 nd cycle of systemic chemotherapy. 18 JS Song, et al. • OIs and primary CNS lymphoma associated with ICL www.icjournal.org Case reportA 59-year-old man came to our hospital with the chief complaint of prolonged fever and watery diarrhea with no identified cause of disease. He had been in good health and had never traveled abroad or abused drugs. In addition, the patient had no history of blood transfusion, homosexuality, or any medical illness.Upon admission, the patient appeared generally ill and cachectic. His vital signs were as follows: blood pressure was 107/60 mmHg, pulse rate 84 beats/min, respiratory rate 19 breaths/min, and axillary body temperature 38.0℃. Upon physical examination, there was no skin lesion, lymphadenopathy, or hepatosplenomegaly. Laboratory studies showed white blood cells 1,230/mm 3 (segmented neutrophils 72%, lymphocytes 7%, monocytes 15%, eosinophils 6%), hemoglobin 11.3 g/dL, platelets 64×10 3 /mm 3 , blood glucose 105 mg/dL, total bilirubin 0.8 mg/dL, aspartate aminotransferase (AST) 68 IU/L, alanin aminotransferase (ALT) 33 IU/L, lactate dehydrogenase (LDH) 410 IU/L, and C-reactive protein 5.28 mg/dL.Chest computed tomography (CT), obtained with radiocontrast dye, showed multifocal ground glass opacities along with nodular consolidations in both lungs and abdomen and pelvic CT showed splenomegaly, heterogeneous liver attenuation, and enlargement of multiple mesenteric lymph nodes.

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

Cited by 18 publications

References 9 publications

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

Solitary pulmonary mass in a patient with a history of lymphoma: a case report

Multiple Opportunistic Infections and Primary Central Nervous System Lymphoma in a Patient with Idiopathic CD4+ T-lymphocytopenia

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