A case of adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma (ATLL) is a human malignancy associated with human T-cell leukemia virus type I (HTLV-I), which frequently involves the skin. ATLL can be diagnosed based on clinicopathological findings and the presence of anti-HTLV-I serum antibodies and monoclonal integrated HTLV-I provirus in the DNA of tumor cells. It is characterized by leukemia, lymphadenopathy, hypercalcemia, and lytic bone lesions. We report a case of ATLL in a 59-year-old man who developed multiple, scattered papules on the face and trunk. He had a 3-month history of melena. The physical examination showed multiple cervical and axillary lymph node enlargements. On laboratory investigation, the white blood cell count was 113,900/mm³ with 70% atypical lymphocytes. Histopathological and immunohistochemical analyses of a skin and stomach biopsy confirmed the diagnosis of T-cell lymphoma. Final diagnosis of ATLL was made based on HTLV-I positivity. The patient underwent multiple cycles of combination chemotherapy and combination therapy of zidovudine and interferon- α which produced some improvement, but he died of pulmonary complications 3 months after the initial diagnosis.