Safety and efficacy of treatment using interleukin-2 in a patient with idiopathic CD4+ lymphopenia andMycobacterium avium-intracellulare
Open Access
- 18 February 2009
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical and Experimental Immunology
- Vol. 156 (3), 440-445
- https://doi.org/10.1111/j.1365-2249.2009.03910.x
Abstract
Summary: We present the case of a 39-year-old white man with a Myobacterium avium-intracellulare pulmonary infection found to have a CD4+ count of 172 cells/mm3 and diagnosed subsequently with idiopathic CD4+ lymphopenia (ICL). After receiving clathromycin for 4 months with minimal improvement, the patient was started on pegylated subcutaneous interleukin (IL)-2 at 600 000 units daily. Later, he received incrementally higher pegylated IL-2 doses until he reached a maintenance dose 3 months later of 11 million units weekly divided into three equal doses. After 5 months of therapy, the patient’s chronic cough resolved completely, sputum cultures became negative for Myobacterium avium-intracellulare and the CD4+ T cell count increased to 553 cells/mm3. After 35 months of well-tolerated IL-2 treatments and no recurrence of any opportunistic infections, IL-2 treatment was stopped. CD4+ counts 6 and 9 months after discontinuing IL-2 treatment were 596 and 378 cells/mm3 respectively, and he remains asymptomatic. This report supports IL-2 treatment for ICL-associated opportunistic infections as a safe and potentially efficacious treatment option, especially when combined with more traditional treatment regimens.Keywords
This publication has 32 references indexed in Scilit:
- Idiopathic CD4+ lymphocytopenia: natural history and prognostic factorsBlood, 2008
- CD4+T Cells but Not CD8+or γδ+Lymphocytes Are Required for Host Protection againstMycobacterium aviumInfection and Dissemination through the Intestinal RouteInfection and Immunity, 2005
- Low‐Dose Prolonged Intermittent Interleukin‐2 Adjuvant Therapy: Results of a Randomized Trial among Human Immunodeficiency Virus–Positive Patients with Advanced Immune ImpairmentThe Journal of Infectious Diseases, 2002
- Idiopathic CD4+ T Cell Lymphocytopenia Evolving to Monoclonal Immunoglobulins and Progressive Renal Damage Responsive to IL-2 TherapyClinical Immunology, 2001
- Idiopathic CD4+ T-Lymphocytopenia -- Four Patients with Opportunistic Infections and No Evidence of HIV InfectionNew England Journal of Medicine, 1993
- Idiopathic CD4+ T-Lymphocytopenia -- An Analysis of Five Patients with Unexplained Opportunistic InfectionsNew England Journal of Medicine, 1993
- Idiopathic CD4+ T-Lymphocytopenia -- Immunodeficiency without Evidence of HIV InfectionNew England Journal of Medicine, 1993
- Unexplained Opportunistic Infections and CD4+ T-Lymphocytopenia without HIV Infection -- An Investigation of Cases in the United StatesNew England Journal of Medicine, 1993
- Natural killer cell-mediated lysis ofMycobacterium-avium complex-infected monocytesJournal of Clinical Immunology, 1990
- COMMON VARIABLE IMMUNODEFICIENCY AND PURINE NUCLEOTIDASE AND NUCLEOSIDE PHOSPHORYLASE DEFICIENCYActa Pathologica Microbiologica Scandinavica Section C Immunology, 1980