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Rare Peritoneal Involvement in Adult T-Cell Leukemia/Lymphoma: A Diagnostic Conundrum
Nithya Krishnamurthy1, Bruce Petersen2, Christian Farag1
1Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus
|August 5, 2025
Summary
This case study details a rapidly fatal presentation of aggressive adult T-cell leukemia/lymphoma (ATLL) with widespread peritoneal involvement. Early diagnosis and consideration of endemic exposures are crucial for managing this aggressive hematologic malignancy.
Area of Science:
- Oncology
- Hematology
- Infectious Disease
Background:
- Adult T-cell leukemia/lymphoma (ATLL) is an aggressive hematologic malignancy associated with human T-cell lymphotropic virus type 1 (HTLV-1).
- Peritoneal involvement in ATLL can present with non-specific abdominal symptoms, mimicking other intra-abdominal pathologies.
Observation:
- A 60-year-old man presented with progressive abdominal pain, early satiety, and weight loss.
- Imaging revealed extensive mesenteric, peritoneal, and pleural involvement with increased FDG uptake, suspicious for lymphomatosis.
- Biopsy confirmed aggressive peripheral T-cell lymphoma, and RT-PCR confirmed HTLV-1 positivity, establishing the diagnosis of ATLL, stage IV.
Findings:
- The patient experienced rapid disease progression with complications including tumor lysis syndrome, small bowel obstruction, and bacteremia.
- Despite preparation for EPOCH chemotherapy, the patient suffered a cardiac arrest and died shortly after presentation.
- This case illustrates a fulminant course of ATLL with extensive extranodal disease.
Implications:
- Highlights the importance of considering endemic HTLV-1 exposure in patients with aggressive lymphoma-like presentations.
- Emphasizes the utility of PET-CT in detecting widespread extranodal disease in ATLL.
- Underscores the challenges in managing rapidly progressive ATLL and its associated acute complications.
