Hello, Lack of CD7 expression might point to HTLV1-driven proliferation. Is that possible here? Ondrej Hrusak >I was looking for thoughts/opinions on a recent flow cytometry case. The >case is that of a 38 year old male who presented with vague complaints, >fever, and malaise that was thought to have a possible viral/infectious >etiology. During his brief admission, a CBC was reviewed due to the presence >of leukocytosis (WBC-17,300/ul) with an absolute lymphocytosis (68% >lymphocytes). Many of the lymphocytes were reactive/atypical, similar to >those often seen with EBV infection. A Monospot was negative. > >Flow cytometry performed on the peripheral blood showed 92% T cells, 7% NK >cells and <1% B cells. Of interest, there was a marked predominance of CD8 >(85%) and loss of expression of CD7. CD4 was present on 15% of cells and >CD2, CD3, and CD5 were present in expected numbers with normal intensity. >Because of the unusual loss of CD7 and predominance of CD8, the specimen was >sent for PCR for TCR-gamma which apparently preliminary shows a clonal >rearrangement. > >In the course of the patient's admission, the patient was found to be HIV >positive (new diagnosis) and also had serologies suggestive of acute >infection with CMV. EBV serologies were negative. The above-described flow >findings have been well-described with EBV infection. In fact, in one of the >recent articles on the Flow Cases Web site (www.flowcases.org), similar >findings are described for a child with acute EBV infection. This child also >had a positive clonal T cell rearrangement which subsequently disappeared >along with the abnormal flow findings when the infection had cleared. > >Has anyone seen similar findings with either HIV and/or CMV infection. If >so, should the patient be followed with repeat flow and/or molecular studies >during the course and management of his newly diagnosed infection. Thanks >for your thoughts. > >Christopher S. Bee, M.D. >Medical Director, Flow Cytometry >Wilford Hall Medical Center >San Antonio, TX >(210) 292-5455 -- . . . . . . . . . . . . . . . . . . . . . . . . . . Ondrej Hrusak, M.D., Ph.D. Institute of Immunology Ondrej.Hrusak@lfmotol.cuni.cz fax +4202 2443 5962 http://www.lf2.cuni.cz/clip/ phone +4202 2443 5969, +4202 2443 2084 postal address: V uvalu 84 150 06 Praha 5 Czech Republic
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