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Idiopathic CD4 Lymphocytopenia Manifesting as Refractory Genital Dysplasia

Allard, Jay E. MD; Lee, Rachel U. MD

doi: 10.1097/AOG.0b013e3182835850
Case Report

BACKGROUND: Idiopathic CD4 lymphocytopenia is an immunodeficiency disorder with low absolute CD4 T-lymphocyte count with no evidence of human immunodeficiency virus or other known cause.

CASE: A 22-year-old woman presented with a high-grade Pap test result. Work-up demonstrated cervical intraepithelial neoplasia 3 and vaginal intraepithelial neoplasia 3 with extensive condyloma. She presented 6 months after her initial treatment with recurrent disease and was referred to the immunology department, where she was found to have profound lymphopenia. After further evaluation, idiopathic CD4 lymphocytopenia was diagnosed.

CONCLUSION: Idiopathic CD4 lymphocytopenia is a rare acquired immunodeficiency. Although genital dysplasia is common in young women, this case demonstrates the importance of determining other etiologies of recurrent human papillomavirus infections and possible immunodeficiencies that may affect management and outcomes.

Idiopathic CD4 lymphocytopenia and acquired immune deficiencies should be considered in cases of refractory genital dysplasia.

Department of Obstetrics and Gynecology and the Division of Allergy and Immunology, Department of Internal Medicine, Naval Medical Center, Portsmouth, Virginia; and the Naval Health Research Center, San Diego, California.

Corresponding author: Commanding Officer LCDR Rachel Lee, Code 166, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106; e-mail: Rachel.Lee@med.navy.mil.

Financial Disclosure The authors did not report any potential conflicts of interest.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. Approved for public release; distribution is unlimited. Human subjects participated in this study after giving their free and informed consent. This research has been conducted in compliance with all applicable Federal Regulations governing the Protection of Human Subjects in Research.

Presented in part at the Navy American College of Physicians meeting, October 7–9, 2010, Portsmouth, Virginia.

© 2013 by The American College of Obstetricians and Gynecologists.