HTLV-positive adult T-cell leukaemia/lymphoma with Epstein-Barr virus and hepatitis B coinfection

Abstract

Human T-cell lymphotropic virus (HTLV) is a human oncoretrovirus known to cause adult T-cell leukaemia/lymphoma (ATLL). Coinfection of human T-lymphotropic virus type 1 with Epstein-Barr virus (EBV) results in enhanced expression of the HTLV virus and leads to aggressive organ involvement from T-cell malignancy. It has also been observed that the prevalence of hepatitis B infection has been higher in patients with HTLV ATLL as compared with the general population in certain countries. We describe a case of a 34-year-old man who initially presented with leucocytosis, fatigue and conjunctival erythema. His radiological images revealed significant generalised adenopathy, and his flow cytometry analysis came back positive for CD4-positive T-cell lymphoma. He was subsequently diagnosed with HTLV-positive ATLL. Ultimately the patient was also diagnosed with acute hepatitis B and EBV. We describe a unique case of ATLL with coinfection with two other viruses, the association of which can be of potential prognostic value in guiding the treatment strategies for ATLL.

Antibody and Cell-Based Therapies against Virus-Induced Cancers in the Context of HIV/AIDS

“…EBV and HTLV-1 are both lymphotropic viruses, with EBV favoring B cells and HTLV-1 showing tropism towards T cells. While singular infections with either virus are often asymptomatic, there are a few instances of acute lymphoproliferative disease or progressive leukemia as the chronic infection progresses [35]. Genetic factors, notably HLA haplotype, have been associated with the development of both EBV-and HTLV-1-associated leukemia/lymphoma.…”

“…EBV antigens, EBNA-1 and LMP-1, are positive in ATLL cells associated with skin malignancies. Studies have also suggested that HTLV-1 infection enhances EBV spread into endothelial and epithelial cells [35,39]. ATLL carries a very poor prognosis due to chemoresistance and significant functional immunosuppression.…”