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Disseminated cryptococcosis in a patient with newly diagnosed HTLV-1 infection
Gabriel Motoa1, Harry Ross Powers2, Lisa M Brumble3
1Division Of Allery and Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Insights
Human T-lymphotropic virus 1 (HTLV-1) infection can cause severe immunosuppression, leading to opportunistic infections like cryptococcosis. This case highlights the critical need for clinicians to recognize HTLV-1 as a cause of severe immune deficiency.
Area of Science:
- Immunology
- Infectious Diseases
- Hematology
Background:
- Human T-lymphotropic virus 1 (HTLV-1) is primarily associated with chronic infections and lymphoproliferative disorders.
- Clinicians often overlook HTLV-1's potential to induce severe immunosuppression.
- Early recognition of HTLV-1-associated immune deficiency is crucial for patient management.
Observation:
- A case report of a woman in her 70s from the Caribbean presenting with fatigue, weight loss, and atypical lymphocytosis.
- Investigations revealed hypercalcemia, pleural effusion, and positive HTLV-1 screening and confirmatory tests.
- The patient was subsequently diagnosed with disseminated Cryptococcus neoformans infection.
Findings:
- The patient presented with symptoms suggestive of an underlying lymphoproliferative disorder or opportunistic infection.
- HTLV-1 infection was confirmed, indicating a potential cause for the patient's compromised immune status.
- Disseminated cryptococcosis developed, leading to severe complications and patient demise despite treatment.
Implications:
- This case underscores the importance of considering HTLV-1 infection in patients with unexplained severe immunosuppression and opportunistic infections.
- Increased awareness among healthcare professionals regarding HTLV-1's immunomodulatory effects is necessary.
- Prompt diagnosis and management of HTLV-1 infection may prevent severe opportunistic infections and improve patient outcomes.
Abstract:
Infection by human T-lymphotropic virus 1 (HTLV-1) is often seen as the cause of chronic infection or lymphoproliferative disorders, but many clinicians do not recognise its association with severe immunosuppression. We report the case of a woman in her 70s from the Caribbean who sought care at the emergency department for weakness, fatigue and weight loss. Further work-up showed atypical lymphocytosis with floral lymphocytes and smudge cells in the peripheral blood smear and hypercalcaemia. Chest CT demonstrated a moderate right pleural effusion. Results of HIV testing were negative, and screening and confirmatory tests for HTLV-1 were positive. Empiric antibiotic therapy was administered, and the patient was discharged home. Five days later, she was readmitted with shortness of breath and severe abdominal pain. A disseminated infection with Cryptococcus neoformans was diagnosed. Despite aggressive intravenous antifungal therapy, the patient died on day 7 of hospitalisation.
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