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Multifaceted adult T-cell leukemia/lymphoma in India: a case series.

Khader A, Shaan M, Balakrishnan S, Ambooken B, Muhammed K, Rajan U - Indian J Dermatol (2015 Jan-Feb)

Bottom Line: Presence of epidermotropism did not correlate with the severity of disease.ATL manifest in myriad presentations and skin lesions are often the earliest manifestation.Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Government Medical College, Calicut, Kerala, India.

ABSTRACT

Background: Adult T-cell leukemia/lymphoma (ATL) 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 five 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 infiltrate 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 florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

No MeSH data available.


Related in: MedlinePlus

Hypopigmented macules in patient 5 with smoldering ATL
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Figure 6: Hypopigmented macules in patient 5 with smoldering ATL

Mentions: A 30-year-old male with history of recurrent eczematous lesions in childhood presented with pruritic hypopigmented scaly macules [Figure 6] over back of 4 months duration. There was cervical lymph node enlargement without hepatosplenomegaly. The total leukocyte count showed mild elevation and few atypical cells in the peripheral smear. Serum calcium, albumin, and blood urea nitrogen were normal. Serum LDH was markedly elevated. Skin biopsy revealed infiltrate of CD3+, CD4+, CD8+, and CD20- atypical lymphocytes in the dermis with epidermotropism. HTLV-1 antibody was positive by ELISA and screening for HIV negative. Smoldering form of ATL was diagnosed in view of skin lesions, absence of hepatosplenomegaly, few atypical cells, and normal serum calcium. The patient denied treatment and is under follow-up for last 12 months.


Multifaceted adult T-cell leukemia/lymphoma in India: a case series.

Khader A, Shaan M, Balakrishnan S, Ambooken B, Muhammed K, Rajan U - Indian J Dermatol (2015 Jan-Feb)

Hypopigmented macules in patient 5 with smoldering ATL
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318027&req=5

Figure 6: Hypopigmented macules in patient 5 with smoldering ATL
Mentions: A 30-year-old male with history of recurrent eczematous lesions in childhood presented with pruritic hypopigmented scaly macules [Figure 6] over back of 4 months duration. There was cervical lymph node enlargement without hepatosplenomegaly. The total leukocyte count showed mild elevation and few atypical cells in the peripheral smear. Serum calcium, albumin, and blood urea nitrogen were normal. Serum LDH was markedly elevated. Skin biopsy revealed infiltrate of CD3+, CD4+, CD8+, and CD20- atypical lymphocytes in the dermis with epidermotropism. HTLV-1 antibody was positive by ELISA and screening for HIV negative. Smoldering form of ATL was diagnosed in view of skin lesions, absence of hepatosplenomegaly, few atypical cells, and normal serum calcium. The patient denied treatment and is under follow-up for last 12 months.

Bottom Line: Presence of epidermotropism did not correlate with the severity of disease.ATL manifest in myriad presentations and skin lesions are often the earliest manifestation.Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Government Medical College, Calicut, Kerala, India.

ABSTRACT

Background: Adult T-cell leukemia/lymphoma (ATL) 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 five 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 infiltrate 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 florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

No MeSH data available.


Related in: MedlinePlus