Histoplasma meningitis with hyperactive suppressor T cells in cerebrospinal fluid

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Abstract
Histoplasma meningitis usually occurs in conjunction with disseminated histoplasmosis. A patient with common variable hypogammaglobulinemia was studied who manifested without disseminated histoplasmosis. No histoplasma antibody was detected in CSF or blood. Evaluation of lymphocyte function in the blood revealed normal numbers of T [thymus-derived] cells with increased numbers of B [bone marrow-derived] cells. Most blood lymphocytes were identifiable, but most lymphocytes in CSF were null cells. Lymphocyte proliferative response to phytohemagglutinin or pokeweed mitogen was poor. T cells in CSF suppressed proliferative responses to histoplasma antigen by cells from blood or CSF, whereas T cells from blood did not. This difference suggested compartmentalization of T cell function. The lack of humoral and cellular response to Histoplasma in CSF may have allowed meningitis to develop, while the cellular response to Histoplasma elsewhere prevented development of disseminated histoplasmosis.

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