Cutaneous plaque in adult T cell leukemia/lymphoma: A case report

Medicine (Baltimore). 2020 Dec 11;99(50):e23491. doi: 10.1097/MD.0000000000023491.

Abstract

Rationale: The rarity of adult T cell leukemia/lymphoma (ATLL) in China, coupled with its clinicopathologic mimicry of primary skin disease, poses a diagnostic challenge. The method of diagnosis and mechanism of immune regulation in ATLL are discussed in the present report.

Patient concerns: A 51-year-old Chinese man was admitted to the hospital with 2-years history of systemic plaque lesions and 1-year history of left ankle joint pain.

Diagnoses: The patient was diagnosed with ATLL based on the results of flow cytometry immunophenotype and human T-cell lymphotropic virus type 1 (HTLV-1) serology.

Interventions: The patient received 3 cycles of cyclophosphamide, epirubicin/ vinorelbine, and dexamethasone (CHOP) chemotherapy. However, he relapsed and did not respond to epirubicin, vindesine, etoposide, dexamethasone (EPOCH) chemotherapy.

Outcomes: His family discontinued the treatment and opted for hospice care.

Lessons: Patch and plaque ATLL types exhibits a better survival rate, but atypical skin patches delays the diagnosis of ATLL and negatively affects the patient survival. Based on the present findings, we suggest that patients with petal-like nuclear lymphocytes in blood smears, a high CD4: CD8 ratio, and strong CD25 expression should undergo HTLV-1 serology testing.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cyclophosphamide / therapeutic use
  • Diagnosis, Differential
  • Doxorubicin / therapeutic use
  • Etoposide / therapeutic use
  • Flow Cytometry
  • Human T-lymphotropic virus 1 / genetics
  • Humans
  • Leukemia-Lymphoma, Adult T-Cell / blood
  • Leukemia-Lymphoma, Adult T-Cell / complications
  • Leukemia-Lymphoma, Adult T-Cell / diagnosis*
  • Leukemia-Lymphoma, Adult T-Cell / drug therapy
  • Male
  • Middle Aged
  • Prednisolone / therapeutic use
  • Prednisone / therapeutic use
  • Skin Diseases / etiology
  • Vincristine / therapeutic use

Substances

  • Vincristine
  • Etoposide
  • Doxorubicin
  • Cyclophosphamide
  • Prednisolone
  • Prednisone

Supplementary concepts

  • EPOCH protocol
  • VAP-cyclo protocol