特发性CD4^+T淋巴细胞减少症伴播散性皮肤隐球菌病

Idiopathic CD4^+T lymphocytopenia in a patient with disseminated skin cryptococcosis

患者女,23岁。左锁骨、腰部右侧及左膝部出现肿块并溃疡4个月,组织病理检查示组织中大量浆细胞及异物巨细胞;PAS染色显示大量散在或成团的孢子,经鉴定证实为新生隐球菌。连续T淋巴细胞亚群分析显示CD4+T淋巴细胞明显减少,占总T淋巴细胞数20%以下。无人类免疫缺陷病毒(HIV)感染。诊断为特发性CD4+T淋巴细胞减少症伴播散性皮肤隐球菌病。主要给予两性霉素B治疗,1个月后溃疡愈合。

A 23-year-old woman presented lumps and ulcers on her left clavicle; right loin and left knee areas for 4 months. Large numbers of plasma cells and foreign-body giant cells were shown in histopathologic examination; and PAS staining demonstrated there were scattered and clumped spores; which were identified as Cryptococcus neoformans. T lymphocyte subgroup analysis showed lymphocytopenia ;with reduction of CD4+ lymphocytes; and CD4+ count was less than 20% of the total T cell count. No evidence of human immunodeficiency virus(HIV) infection was found. Idiopathic CD4+T lymphocytopenia with disseminated skin cryptococcosis was diagnosed. Amphotericin B was given to the patient; the ulcers healed after one month.