Adult T-cell lymphoma/leukaemia with haematemesis as a prodromal manifestation

We report a case of adult T-cell leukaemia/lymphoma (ATLL) with haematemesis as a prodromal manifestation. The patient was a 34-year-old woman from Yazd. She also gave a history of a fluctuating skin lesions consisting of non-pruritic papules and ulcers on her feet. Upper gastrointestinal endoscopy disclosed obvious nodularities without ulceration in the antrum of the stomach. Histological and immunohistochemical studies of the gastric biopsy specimen showed lymphomatous infiltration of diffuse pleomorphic type with a T-cell phenotype. Laboratory investigations revealed leucocytosis (consisting of highly atypical lymphocytes, many with clover-leaf-shaped nuclei) and hypercalcaemia. She was found to be seropositive for human T-lymphotropic virus type 1. A diagnosis of overt ATLL was made. The findings in this case indicate that an awareness of the existence of this disease in a non-endemic area such as Yazd is necessary to avoid potential misdiagnosis and be helpful in appropriate therapeutic decision.