Adult T‐cell leukemia/lymphoma clinically confused with viral/drug skin eruptions and pathologically misinterpreted as mycosis fungoides/Sézary syndrome

Abstract

Adult T‐cell leukemia/lymphoma (ATLL) is a lymphoproliferative disorder of mature CD4‐positive T‐cell lymphoid cells associated with retrovirus human T‐lymphotropic virus type‐1 (HTLV‐1) with a wide clinical and pathologic spectrum. We report a case of a 53‐year‐old African man who presented with fever and skin eruptions on the trunk composed of non‐itchy erythematous reticulated macules and papules initially suspected for viral exanthem or drug rash. Skin punch biopsy showed a dermal T‐cell lymphoid infiltrate with epidermotropism. The patient developed generalized lymphadenopathy and his peripheral blood showed lymphocytosis with atypical lymphocytes with convoluted nuclei. Our initial diagnosis was mycosis fungoides with Sézary syndrome. However, some clinical and histopathologic features were unusual. The acute onset, lack of previous skin lesions, the histomorphologic features of the dermal, nodal and peripheral blood lymphocytes and the geographic origin of the patient raised the suspicion of other T‐cell lymphomas, particularly ATLL. This was confirmed by a positive anti‐HTLV‐1 serology. Our final diagnosis was acute variant ATLL. Different T‐cell lymphomas can involve the skin with overlapping clinical, histomorphologic and immunohistochemical features. Some clinical and pathologic features should alarm dermatologists and pathologists to the possibility of ATLL particularly in patients from HTLV‐1 endemic geographic areas.

Whole-Transcriptome Sequencing–Based Profiling of the Cutaneous Virome in Patients with Secondary Immunodeficiency

“…Patient 6 had an interesting, rare, and unusual presentation with erythrodermic poikiloderma–like lesions, primarily on the arms and legs. Without HTLV1, clinical, pathology, and imaging data suggest the clinical diagnosis of mycosis fungoides with Sézary syndrome ( AbdullGaffar and Abdulrahman, 2021 ). RNA-Seq identified HTLV1 in her skin, leading to suspicion of adult T-cell leukemia/lymphoma, a rare T-cell leukemia/lymphoma affecting adults caused by the HTLV1 virus.…”

Заболевания, Ассоциированные С Т-Лимфотропным Вирусом Типа 1 Человека (HTLV-1)

“…У пациентов с АТLL описаны инфильтративные папулезные и узловые поражения кожи, особенно на лбу, а также на нижних и верхних конечностях, кожные высыпания на туловище, состоящие из незудящих эритематозных сетчатых пятен и папул, первоначально диагностированных как вирусная экзантема или сыпь, вызванная лекарствами [24]. Острое начало, отсутствие предшествующих поражений кожи, гистоморфологические особенности лимфоцитов дермы и периферической крови, а также географическое проживание пациента позволяют заподозрить АТLL [25].…”

A patient with acute-type adult T-cell leukemia/lymphoma that rapidly progressed after Helicobacter pylori eradication therapy

“…To the Editor: Adult T-cell leukemia/lymphoma (ATLL) causes polymorphous skin lesions and several cases of ATLL involving clinically suspected drug eruptions have been reported [1]. However, no cases in which drug treatment triggered the rapid progression of ATLL have ever been reported to our knowledge.…”