[CIS PIDD] Warts and T-cell lymphopenia

[Kirkpatrick, Charles]

I am evaluating a 48 y/o Caucasian male who developed extensive warts on his hands and feet  about 1998 but spreading widely over feet and hands since 2003.  He was well until then, but he had a cutaneous VZV infection shortly before the onset of warts.  There have been no genital lesions. Failed treatments include liquid nitrogen, Aldara, topical sensitization and application of 2% and 4% CDNB, intralesional injections of Candida skin test antigen, V-Beam laser treatments, duct tape and many herbal and OTC medications.

Labs:  HIV - negative X2, CBC normal, IgG, IgA, IgM all normal, absolute CD3 - 260/ul; CD4 190/ul; CD8 - 60/ul; CD45/CD4 RA 2.3% of total T-cells (control 57.7%); CD45/CD4/RO -96.8% of total T-cells (control 40.8%).
T-cell proliferations to PHA, ConA and PWM all low; proliferation response to tetanus - low; to Candida normal.  DTH to Candida 28 mm induration.

Any comments about diagnosis?  Does anyone have experience with topical or intravenous Cidifovir in patients such as this?

All comments appreciated.

Charles Kirkpatrick, M.D.
Allergy and Immunology
University of Colorado Health Sciences Center
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