The CD4 lymphocytes are an important part of the immune system. Besides HIV Infection, other conditions can cause a low CD4 count. We report the case of a 82-year-old female who presented with a markedly low CD4 count during a severe lower respiratory tract infection and respiratory failure without HIV infection. The total lymphocyte and the absolute CD4 counts are 255/mm³ and 109/mm³, respectively. Sputum and bronchial lavage fluid were both negative for acid-fast bacilli. The anti-HIV antibody test was negative.The blood culture was also negative. She had no history of diabetes, malnutrition or chronic kidney disease. Because pneumocystis jiroveci pneumonia could not be excluded, she was treated with a combination of clindamycin, dexamethasone, primaquine, meropenem and oseltamivir because of sulfamethoxazole drug allergy. One week later, she developed herpes simplex of her labia majora, so acyclovir was added. She had history of having a normal lymphocyte count during her routine yearly check-up. Her severe respiratory tract infection was associated with CD4 lymphocytopenia.
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