IDIOPATHIC CD4-LYMPHOCYTOPENIA WITH FATAL SALMONELLA-TYPHIMURIUM SEPTICEMIA

In April 1991, a then 43-year-old woman fell ill with a systemic crypt ococcal infection which responded well to antimycotic treatment. Four months later she was found to have a T-helper cell deficiency (48/mu l , 15%). Since August 1992 she noted an increased tendency towards infe ctions and had recurrent fever bouts over 4 weeks, which led to her ho spitalization in January 1993. Repeated HIV tests were negative. Durin g the first 4 days she was free of infection, but developed a temperat ure of 39.1 degrees C on the fifth day, and within a few hours a fulmi nant septicaemia with cardiorespiratory failure developed ending fatal ly the same day. Blood cultures drawn during fever bouts grew Salmonel la typhimurium by the time of her death. Lymphocyte differentiation re vealed absolute and relative reduction in the number of CD4-lymphocyte s (158/mu l; 18%), retrospectively providing the diagnosis of idiopath ic CD4-lymphocytopenia. - In cases such as this there is the need of i ncluding opportunistic and masked disease entities in the differential diagnosis, even in the absence of HIV infections, and start early tre atment.