Prolonged lymphocytosis as the first manifestation of Hodgkin-like adult T-cell leukemia/lymphoma

Braz J Infect Dis. Jan-Feb 2017;21(1):119-122. doi: 10.1016/j.bjid.2016.09.005. Epub 2016 Oct 24.

Abstract

Hodgkin-like ATLL is a rare variant of adult T-cell leukemia/lymphoma (ATLL), a disease caused by human T-cell lymphotropic virus type-1 (HTLV-1). At admission, a 46-year-old female presented with lymphadenomegaly, lymphocytosis, slight elevation of LDH blood level, and acid-alcohol resistant bacilli in sputum and was being treated for pulmonary tuberculosis (Tb). She had lymphocytosis in the previous 20 months. Serology for HTLV-1 was positive. Lymph node was infiltrated by medium-sized lymphocytes with scattered Hodgkin and Reed-Sternberg-like cells CD30+, CS1-4+, and CD79a+. Background cells were CD4+ and CD25+. A clinical diagnosis of favorable chronic ATLL was given. She was treated with chemotherapy but later progressed to acute ATLL and ultimately died. Hodgkin-like ATLL should be considered in the histological differential diagnosis with Hodgkin lymphoma since treatment and prognosis of these diseases are distinct. It is also important to search for HTLV-1 infection in patients with unexplained prolonged lymphocytosis.

Keywords: Adult T-cell leukemia/lymphoma; HTLV-1 infection; Hodgkin-like ATLL; Pulmonary tuberculosis.

Publication types

  • Case Reports

MeSH terms

  • Biopsy
  • Enzyme-Linked Immunosorbent Assay
  • Fatal Outcome
  • Female
  • HTLV-I Infections / pathology*
  • Hodgkin Disease / pathology*
  • Hodgkin Disease / virology
  • Human T-lymphotropic virus 1 / isolation & purification
  • Humans
  • Leukemia-Lymphoma, Adult T-Cell / pathology*
  • Leukemia-Lymphoma, Adult T-Cell / virology
  • Lymph Nodes / pathology
  • Lymphocytosis / pathology*
  • Lymphocytosis / virology
  • Middle Aged