Safety and efficacy of treatment using interleukin-2 in a patient with idiopathic CD4(+) lymphopenia and Mycobacterium avium-intracellulare.

Abstract

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/mm(3) 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/mm(3). 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/mm(3) 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.

• Authors: T Trojan, R Collins, D A Khan
• Journal: Clinical and experimental immunology (Clin Exp Immunol) Vol. 156 Issue 3 Pg. 440-5 (Jun 2009) ISSN: 1365-2249 [Electronic] England
• PMID: 19438596 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Interleukin-2

Topics

• Adult
• CD4 Lymphocyte Count
• CD4-Positive T-Lymphocytes (immunology)
• Humans
• Interleukin-2 (therapeutic use)
• Lymphopenia (complications, drug therapy, immunology)
• Male
• Mycobacterium avium-intracellulare Infection (complications, drug therapy, immunology)
• Opportunistic Infections (complications, drug therapy, immunology)