A Case of Adult T-Cell Leukemia/Lymphoma Complicated with Bilateral Chylothorax

Abstract

We present the case of a 74-year-old Japanese woman who presented with dyspnea, a palpable right breast mass, and swollen right axillary lymph node. Imaging studies revealed bilateral pleural effusion and systemic lymph adenopathy and pleural fluid study showed high levels of triglycerides. A right inguinal lymph node biopsy disclosed malignant lymphoma cells that were human T-cell leukemia virus type 1 (HTLV-1) provirus DNA-positive, a condition endemic to patient’s birthplace, by the Southern blot hybridization method. She was diagnosed as having adult T-cell leukemia/lymphoma (ATL) with chylothorax. After commencing chemotherapy for ATL, her chylothorax disappeared and swollen lymph nodes reduced remarkably, indicating an association between the chylothorax and ATL. Bilateral chylothorax is a relatively rare condition associated with such nontraumatic causes as ATL. Clinicians should therefore bear chylothorax in mind when encountering patients with pleural effusion. A detailed medical history can also enable prompt diagnosis and appropriate treatment.

The challenge of describing the epidemiology of HTLV in the Amazon region of Brazil

“…HTLV integrates the transcribed RNA as a DNA provirus into the cell nucleic acid [12][13][14][15][16], and this simple evolutionary procedure leads to the persistence of the virus and its maintenance in nature and has serious implications for the different clinical and epidemiological outcomes of the infection and diseases associated with the virus. The wide array of clinical outcomes shows the target complexity within the human host (including the CNS, blood, lungs, eyes, muscles, bladder and skin), and several medical specialties have to be involved in the care and treatment of infected and diseased persons [17][18][19][20][21][22][23][24][25][26][27].…”

Brazilian Protocol for Sexually Transmitted Infections 2020: human T-cell lymphotropic virus (HTLV) infection

“…HTLV-1 infection shows a great variety of interactions with the human host and important clinical manifestations have been recognized in the eye 58 - 61 , skin 61 , 62 , lung 61 , 63 - 65 , joints 66 - 68 , thyroid 69 , 70 , heart 61 , 71 , 72 , intestines 61 , 73 and bladder 61 , 74 , 75 , among others. The broad spectrum of diseases reveals the infection's clinical complexity, which requires multidisciplinary attention for the infected patients' care.…”

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecção pelo vírus linfotrópico de células T humanas (HTLV)

“…El HTLV-1 está asociado con un linfoma agresivo, la enfermedad llamada leucemia/ linfoma de células T adultas (adult T cell leukemia/ lymphoma, ATLL), 51,52 y a una enfermedad neurodegenerativa, mielopatía asociada con HTLV-1 (HTLV-1 associated myelopathy, HAM). [53][54][55][56][57] La infección por HTLV-1 muestra una amplia variedad de interacciones con el huésped humano y se han reconocido importantes manifestaciones clínicas en los ojos, [58][59][60][61] piel, 61,62 pulmón, 61,[63][64][65] articulaciones, [66][67][68] tiroides, 69,70 corazón, 61,71,72 intestino, 61,73 y vejiga, 61,74,75 entre otros. El amplio espectro de enfermedades revela la complejidad clínica de la infección, por lo que requiere una atención multidisciplinar en el cuidado de los infectados.…”