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I suggest that your problem is more a clinical than a flow cytometric one.
Please ask your clinician about clinical findings on cutaneous symptoms,
ultrasound of the liver (serch for lymphomas), signs of autoimmunity, signs for
viral infection (the most likely reason).
Without having seen your multicolour dot plots the findings seem to be reactive
and polyclonal esp. when you calculate absolute numbers. Review the blood smear
to look for antiviral cells as your CD4/8 ratio is below 0.5.
CD23 is validated mostly for B-CLL and not helpful for differential diagnosis of
T-NHL or infectious diseases. So the clinician and the patient do not worry
about CD23. We will keep an eye on it (please consider the clone used as we and
others have seen significant differences among several CDs).
How long does this finding persist and how stable is it?
Review virus serology carefully (chronic viral infection (EBV, CMV, Hepatitis
viruses), inability to mount IgG response? Serology may remain unresolved and
the blood film beeing the the only hints for viral infection. Flow cytometry to
my knowledge in infectious desease other than HIV is little diagnostic for a
certain pathogen.
It would be nice from you to report the clinical outcome of this case in order
to shed some light on this dark side of the moon.
Best regards
C. Thomas Nebe
Klinikum Mannheim, Central Laboratory
Faculty for Clinical Medicine of the University of Heidelberg
D- 68135 Mannheim, GERMANY
VOX: +49 621 383-3485
FAX: +49 621 383-3819
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