IDIOPATHIC CD4-LYMPHOCYTOPENIA IN 2 PA TIENTS WITHOUT EVIDENCE OF HIV-INFECTION( T)

We report on two patients with idiopathic CD4+T cell depletion. A 26 y ear-old woman presented to us with acute respiratory failure requiring mechanical ventilation. Despite combined antibiotic therapy parentera lly the opacities increased in the chest X-ray. An open lung biopsy wa s performed and led to the histological diagnosis of bronchiolitis obl iterans organizing pneumonia (BOOP). Respiratory function was improved impressively by high dose parenteral cortisone administration. This p atient showed a general lymphocytopenia with severe CD4+T cell depleti on (60(37%)/mm3 blood). The CT4+T cell concentration increased during a follow up period of 14 months, but did not reach normal values. The second patient was a 33 year-old homosexual. He was admitted with a mu cocutaneous fungal infection which was successfully treated by antifun gal drugs. This patient demonstrated a transient CD4+T cell depletion (350(32%)/mm3 blood). In both patients HIV type 1 and 2 infections wer e excluded by antibody- and p 24-antigen testing, polymerase chain rea ction and virus culture. Conclusion, Idiopathic CD4+T lymphocytopenia differs from HIV infection in immunological profile, in the tendency t o reversal of the CD4+T cell depletion over time and in its better pro gnosis. It is unclear if this is a new syndrome and whether a transmis sible agent, or possibly a genetically-determined reaction to noxious agents is responsible.