10 year old boy with Idiopathic CD4 lymphocytopenia (ICL) and Cervical node MDR-T B - A rare case report

Idiopathic CD4 lymphocytopenia (ICL) is defined as CD4 count 300 cellsmm3 or a CD4 count that is 20 percent of the total T cell count on 2 occasions, with absence of HIV infection and absence of any defined immunodeficiency. We report a 10 year old boy who presented with complaints of multiple swellings with discharging sinus in the neck with history of ATT intake since the age of two and half years due to non resolution of swelling with sinus. Culture and sensitivity test for MTB was done and was diagnosed as Extra pulmonary (cervical node) MDR-TB. In this child the CD4 counts at 6 months interval met CDC criteria for ICL (155 Cellsmm3 in Dec, 2010 and 147 cellsmm3 in May, 2011). Reversal of CD4CD8 ratio was present. Patient has no other opportunistic infection except for cervical node MDR-TB. To our best knowledge this is one of those rare cases in paediatric age group which warrants a mention, not only because of CD4 depletion and but also presence of extra pulmonary (cervical node) MDR TB in a 10 year old boy. The child is now on Interferon and DOTS PLUS therapy and doing well.