Limits...
A case of post-transplant adult T-cell leukemia/lymphoma presenting myelopathy similar to but distinct from human T-cell leukemia virus type I (HTLV- I)-associated myelopathy.

Kawamata T, Ohno N, Sato K, Kobayashi M, Jo N, Yuji K, Tanosaki R, Yamano Y, Tojo A, Uchimaru K - Springerplus (2014)

Bottom Line: Her symptoms recurred 5 months later, when a cerebrospinal fluid (CSF) specimen showed increased CD4 + CXCR3 + CCR4+ cell numbers and levels of neopterin and CXCL10 (IP-10).These results suggest the possible involvement of a certain immunological mechanism such as HAM in her symptoms, irrespective of the lack of anti-HTLV-I antibody in her CSF.Because a definitive diagnosis of CNS manifestation of ATL is sometimes difficult, multi-modal laboratory data are required for differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.

ABSTRACT

Introduction: Adult T-cell leukemia/lymphoma (ATL) responds poorly to conventional chemotherapy, but allogeneic stem cell transplantation (allo-SCT) may improve disease prognosis. Herein, we report a female patient with human T-cell leukemia virus type I (HTLV-I)-associated myelopathy (HAM)-like myelopathy following allo-SCT for ATL.

Case report: She developed crural paresis 14 months after allo-SCT. Initially, she was diagnosed with central nervous system (CNS) relapse of ATL and treated with intrathecal injection and whole brain and spine irradiation. Her symptoms recurred 5 months later, when a cerebrospinal fluid (CSF) specimen showed increased CD4 + CXCR3 + CCR4+ cell numbers and levels of neopterin and CXCL10 (IP-10).

Discussion: These results suggest the possible involvement of a certain immunological mechanism such as HAM in her symptoms, irrespective of the lack of anti-HTLV-I antibody in her CSF. Because a definitive diagnosis of CNS manifestation of ATL is sometimes difficult, multi-modal laboratory data are required for differential diagnosis.

No MeSH data available.


Related in: MedlinePlus

MRI findings. A) At the onset of neurogenic disorder in July 2012. Multiple high-intensity lesions in T2-weighted images (T2WI) of the medulla oblongata, cervical spinal cord, and thoracic spinal cord were revealed. B) Residual high-intensity lesion in Th3-7. C) Following treatment, the residual lesion in the thoracic spinal cord improved.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4197197&req=5

Fig2: MRI findings. A) At the onset of neurogenic disorder in July 2012. Multiple high-intensity lesions in T2-weighted images (T2WI) of the medulla oblongata, cervical spinal cord, and thoracic spinal cord were revealed. B) Residual high-intensity lesion in Th3-7. C) Following treatment, the residual lesion in the thoracic spinal cord improved.

Mentions: In July 2012 (14 months after allo-PBSCT), the patient developed hemiparesis of the left side. Although left upper-limb paresis improved, lower-extremity paresis progressed to paraplegia. Magnetic resonance imaging (MRI) revealed multiple high-intensity lesions in T2-weighted images of the medulla oblongata, cervical spinal cord, and thoracic spinal cord (Figure 2A), and a CSF specimen showed increased cell counts (Figure 3). Morphologically, typical ATL cells such as flower cells were not detected in CSF, but abnormal small to middle size lymphocytes indistinguishable from ATL cells increased. She was diagnosed as CNS relapse of ATL, and received mPSL pulse, intrathecal injection of MTX 15 mg + Ara-C 40 mg + PSL 20 mg, and irradiation of the whole brain and spine. Following these treatments, the paraplegia improved gradually to such a degree that she could walk with a walker. During the course of these treatments, she was complicated by neurogenic bladder dysfunction, and diabetes insipidus.Figure 1


A case of post-transplant adult T-cell leukemia/lymphoma presenting myelopathy similar to but distinct from human T-cell leukemia virus type I (HTLV- I)-associated myelopathy.

Kawamata T, Ohno N, Sato K, Kobayashi M, Jo N, Yuji K, Tanosaki R, Yamano Y, Tojo A, Uchimaru K - Springerplus (2014)

MRI findings. A) At the onset of neurogenic disorder in July 2012. Multiple high-intensity lesions in T2-weighted images (T2WI) of the medulla oblongata, cervical spinal cord, and thoracic spinal cord were revealed. B) Residual high-intensity lesion in Th3-7. C) Following treatment, the residual lesion in the thoracic spinal cord improved.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197197&req=5

Fig2: MRI findings. A) At the onset of neurogenic disorder in July 2012. Multiple high-intensity lesions in T2-weighted images (T2WI) of the medulla oblongata, cervical spinal cord, and thoracic spinal cord were revealed. B) Residual high-intensity lesion in Th3-7. C) Following treatment, the residual lesion in the thoracic spinal cord improved.
Mentions: In July 2012 (14 months after allo-PBSCT), the patient developed hemiparesis of the left side. Although left upper-limb paresis improved, lower-extremity paresis progressed to paraplegia. Magnetic resonance imaging (MRI) revealed multiple high-intensity lesions in T2-weighted images of the medulla oblongata, cervical spinal cord, and thoracic spinal cord (Figure 2A), and a CSF specimen showed increased cell counts (Figure 3). Morphologically, typical ATL cells such as flower cells were not detected in CSF, but abnormal small to middle size lymphocytes indistinguishable from ATL cells increased. She was diagnosed as CNS relapse of ATL, and received mPSL pulse, intrathecal injection of MTX 15 mg + Ara-C 40 mg + PSL 20 mg, and irradiation of the whole brain and spine. Following these treatments, the paraplegia improved gradually to such a degree that she could walk with a walker. During the course of these treatments, she was complicated by neurogenic bladder dysfunction, and diabetes insipidus.Figure 1

Bottom Line: Her symptoms recurred 5 months later, when a cerebrospinal fluid (CSF) specimen showed increased CD4 + CXCR3 + CCR4+ cell numbers and levels of neopterin and CXCL10 (IP-10).These results suggest the possible involvement of a certain immunological mechanism such as HAM in her symptoms, irrespective of the lack of anti-HTLV-I antibody in her CSF.Because a definitive diagnosis of CNS manifestation of ATL is sometimes difficult, multi-modal laboratory data are required for differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.

ABSTRACT

Introduction: Adult T-cell leukemia/lymphoma (ATL) responds poorly to conventional chemotherapy, but allogeneic stem cell transplantation (allo-SCT) may improve disease prognosis. Herein, we report a female patient with human T-cell leukemia virus type I (HTLV-I)-associated myelopathy (HAM)-like myelopathy following allo-SCT for ATL.

Case report: She developed crural paresis 14 months after allo-SCT. Initially, she was diagnosed with central nervous system (CNS) relapse of ATL and treated with intrathecal injection and whole brain and spine irradiation. Her symptoms recurred 5 months later, when a cerebrospinal fluid (CSF) specimen showed increased CD4 + CXCR3 + CCR4+ cell numbers and levels of neopterin and CXCL10 (IP-10).

Discussion: These results suggest the possible involvement of a certain immunological mechanism such as HAM in her symptoms, irrespective of the lack of anti-HTLV-I antibody in her CSF. Because a definitive diagnosis of CNS manifestation of ATL is sometimes difficult, multi-modal laboratory data are required for differential diagnosis.

No MeSH data available.


Related in: MedlinePlus