CD4+ T lymphocytopenia with disseminated HPV

Background:  There have been several reports of HIV‐negative patients with chronic idiopathic CD4+ T lymphocytopenia, the diagnostic criteria for which are: depressed numbers of circulating T lymphocytes (less than 300/µl or less than 20%) on more than one occasion; no laboratory evidence of HIV‐1 or HIV‐2 infection; and the absence of any defined immunodeficiency or therapy associated with depressed levels of CD4+ T lymphocytes. Methods: We report a patient with disseminated human papillomavirus infection associated with idiopathic CD4+ T‐cell lymphocytopenia. A 50‐year‐old woman presented to the dermatology clinic with a 10‐year history of widespread verrucae involving the skin and the cervix. Results: Biopsy from the arm revealed a common wart. PCR analysis performed from the paraffin‐embedded block was strongly positive for HPV type 2. Other HPV types (including EV‐associated HPV 5, 8, 14, 15, 17) were not found. Further laboratory work up revealed T‐cell lymphocytopenia, with an absolute CD4 count of 21. HIV tests were repeatedly negative. She was treated with interferon A 8 million units SQ three times per week with partial improvement. The patient underwent a hysterectomy for cervical dysplasia and a vulvectomy for vulvar intraepithelial neoplasia. She developed small‐cell lung carcinoma and died. Conclusions: The diagnosis of idiopathic CD4+ T‐cell lymphocytopenia should be considered in any patient with widespread viral, fungal, or mycobacterial infection whose HIV test is negative, and appropriate evaluation of the absolute CD4+ counts should be performed.