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HTLV-I-associated myelopathy in a patient with adult T-cell leukemia
1Department of Dermatology, Hokkaido University School of Medicine, Sapporo, Japan.
Abstract:
Disseminated erythematous papules and plaques developed in a 60-year-old man 3 years before the appearance of neurologic manifestations. A biopsy specimen of the plaque revealed Pautrier's microabscess and a dense mononuclear cell infiltration with atypical convoluted nuclei in the papillary dermis. These cells were helper/inducer T lymphocytes that expressed the interleukin 2 receptor. The patient's white blood cell count was normal, but 1% atypical lymphocytes and a high titer of anti-human T-lymphotropic virus (HTLV)-I antibody were detected in his serum. A smoldering type of adult T-cell leukemia was diagnosed. While he was being treated with PUVA, a gait disturbance developed. A high titer of anti-HTLV-I antibody, characteristic of HTLV-I-associated myelopathy, was demonstrated in his cerebrospinal fluid.
Insights
This study details a 60-year-old man with skin lesions and adult T-cell leukemia linked to human T-lymphotropic virus type I (HTLV-I). Neurologic symptoms developed later, confirming HTLV-I-associated myelopathy.
Area of Science:
- Dermatology
- Neurology
- Oncology
- Virology
Background:
- Adult T-cell leukemia (ATL) is a lymphoproliferative malignancy.
- Human T-lymphotropic virus type I (HTLV-I) is the causative agent of ATL.
- ATL can present with diverse clinical manifestations, including cutaneous and neurologic involvement.
Observation:
- A 60-year-old male presented with disseminated erythematous papules and plaques preceding neurologic symptoms by 3 years.
- Skin biopsy revealed Pautrier's microabscesses and atypical T-lymphocytes expressing the interleukin-2 receptor.
- The patient had a high titer of anti-HTLV-I antibodies in serum and cerebrospinal fluid.
Findings:
- A diagnosis of smoldering adult T-cell leukemia was made.
- The patient developed a gait disturbance during PUVA treatment.
- Cerebrospinal fluid analysis confirmed high anti-HTLV-I antibody titers, indicative of HTLV-I-associated myelopathy.
Implications:
- This case highlights the potential for cutaneous manifestations to precede neurologic disease in HTLV-I infection.
- It underscores the importance of considering HTLV-I in patients with both dermatologic and neurologic conditions.
- Early diagnosis and monitoring are crucial for managing HTLV-I-associated myelopathy and adult T-cell leukemia.