Acute adult T-cell leukemia/lymphoma (ATL) presenting with cutaneous purpuric lesions: A rare presentation (original) (raw)
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Journal of the American Academy of Dermatology, 2015
Limited data exist regarding cutaneous involvement of adult T-cell leukemia/lymphoma (ATLL), particularly in the United States. We sought to characterize clinical and histopathologic features of ATLL in patients with skin involvement. We retrospectively identified patients with ATLL from a single institution given a diagnosis during a 15-year period (1998-2013). Patients were categorized by the Shimoyama classification and stratified into skin-first, skin-second, and skin-uninvolved courses. The study population included 17 skin-first, 8 skin-second, and 29 skin-uninvolved cases. Skin-first patients (6 acute, 1 lymphoma, 4 chronic, 6 smoldering) were overwhelmingly of Caribbean origin (94%). They had longer median symptom duration (11.9 vs 1.9 months, P < .001) and overall survival (26.7 vs 10.0 months, P < .001) compared with skin-second/skin-uninvolved patients. Cutaneous lesion morphology at diagnosis included nodulotumoral (35%), multipapular (24%), plaques (24%), patches ...
Acta Dermato Venereologica, 2010
Prurigo nodularis is a pruritic dermatosis of unknown origin. Human T-cell lymphotropic virus type 1 (HTLV-1) causes adult T-cell leukaemia/lymphoma. HTLV-1 is not considered to be a cause of prurigo nodularis. A 52-year-old black man, from the French West Indies, who had had prurigo nodularis for 12 years, presented with a distinct micropapular eruption with the typical pathological picture of epidermotropic T-cell lymphoma. Based on HTLV-1-positive serology and monoclonal integration of HTLV-1 we diagnosed smouldering adult T-cell leukaemia/lymphoma. Re-examinination of previous skin biopsies revealed that the disease had been evolving for 12 years. Treatment with α-interferon, 3 × 10 6 units three times a week, associated with zidovudine, 1 g daily, resulted in complete remission within 4 months. When investigating a prurigo nodularis, we therefore recommend: (i) performing HTLV-1 serology if the patient comes from an endemic area; (ii) if positive, performing CD25 staining and looking for a HTLV-1 clonal integration; and (iii) if positive, using a treatment targeting HTLV-1.
The Journal of dermatology, 2015
Human T-lymphotropic virus type 1 (HTLV-1) induces adult T-cell leukemia/lymphoma (ATLL), HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and carrier. ATLL is a mature CD4(+) CD25(+) CCR4(+) T-cell neoplasm, and approximately half of patients have direct skin involvement manifesting patch, plaque, tumor, multiple papules, erythroderma and purpura. However, there exist secondary eruptions without tumor cell infiltration in patients with ATLL or HAM/TSP and carriers of HTLV-1. To clarify the presence of reactive skin eruptions in HTLV-1-infected individuals, we reviewed our patients with HTLV-1-associated diseases. In 2002-2012, we saw 50 ATLL or HAM/TSP patients and HTLV-1 carriers presenting with skin lesions. We retrospectively selected cases that histologically showed lichenoid tissue reactions with predominant infiltration of CD8(+) T cells, but not CD4(+) tumor cells. The cases included erythroderma (HTLV-1 carrier), lichen planus (HTLV-1 carrier), alopecia a...
Journal of the American Academy of Dermatology, 1987
A woman who emigrated to the United States from the Dominican Republic developed the first signs of cutaneous T cell lymphoma during the last trimester of her pregnancy. This patient, found to have a positive reaction against human T-lymphotropic (leukemia-lymphoma) virus type I (HTLV-I), was followed up prospectively from the appearance of the initial skin lesion to the development of high-count helper T cell leukemia. Aritibodies reactive with the core protein of HTLV-I were also identified in her husband and mother but not in her 2-year-old daughter. Examination of the patient's course provides clues about the latency period and transmission of HTLV-I and highlights similarities between HTLV-I-positive and HTLV-I-negative cutaneous T cell lymphoma. (J AM ACAD DERMATOL 1987;17:903-9.) Human T-lymphotropic (leUkemia-lymphoma) virus type I (HTLV-I) has been associated with a particularly aggressive form of T cell lymphoma, which is endemic to southwestern Japan and the Caribbean islands. I~ Recent data suggest that the disease is also present in Africa 4 and South America
Multifaceted Adult T Cell Leukemia/Lymphoma in India: A Case Series
Background: Adult T cell leukemia/lymphoma is caused by human T cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India. Aims and objectives: The objective was to describe skin manifestations in various types of ATL. Materials and Methods: Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in fi ve patients. Flow cytometry was performed in two cases. Results: Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infi ltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period. Conclusions: ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to fl orid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.
The American journal of tropical medicine and hygiene, 2003
Dermatologic manifestations are quite common in patients with adult T cell leukemia/lymphoma and myelopathy/tropical spastic paraparesis associated with infection with human T cell lymphotropic virus type-1 (HTLV-1). In this study, we evaluated the dermatologic lesions of eligible blood donors in the state of Minas Gerais in Brazil who were seropositive but asymptomatic for infection with HTLV-1. The study population was composed of 128 HTLV-1-seropositive individuals and 108 seronegative controls. All individuals underwent a dermatologic evaluation. Biopsy specimens were obtained from abnormal and normal skin samples of seropositive individuals in an attempt to detect HTLV-1 in tissue samples by a polymerase chain reaction. Dermatologic alterations were observed more frequently in the seropositive group (adjusted odds ratio [OR] = 8.77, 95% confidence interval [CI] = 4.11-18.71). The most common skin diseases were dermatophytoses (adjusted OR = 3.32, 95% CI = 1.50-7.35), seborrheic...