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Right arrow HIV infection, AIDS
CMAJ • February 18, 2003; 168 (4)
© 2003 Canadian Medical Association or its licensors

PRACTICE

A cryptic cause of cryptococcal meningitis

Matthew C. Cheung, Anita R. Rachlis and Steven L. Shumak

From the Division of General Internal Medicine (Cheung and Shumak) and the Division of Infectious Diseases (Rachlis), Department of Medicine, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Toronto, Ont.

Correspondence to: Dr. Steven L. Shumak, A442, 2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-4563; steven.shumak{at}swchsc.on.ca

Abstract

Cryptococcus neoformans commonly causes opportunistic infection in immunocompromised patients, especially in patients with AIDS. The CD4+ T-lymphocyte count is measured in patients with HIV infection, because it signals an increased risk of opportunistic infection and a decline in immunological function. We report a case of cryptococcal meningitis in a patient with persistently low CD4+ cell counts without evidence of HIV infection. The patient's underlying immunocompromised state was attributed to idiopathic CD4+ T-lymphocytopenia (ICL), a recently described syndrome characterized by depletions in the CD4+ T-cell subsets without evidence of HIV infection. Immunodeficiency can exist in the absence of laboratory evidence of HIV infection, highlighting the importance of evaluating T-cell subsets in patients who present with unusual infections.