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

Abstract

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.