ADULT T-CELL LEUKEMIA / LYMPHOMA COMPLICATED WITH SAPROCHAETE CAPITATA FUNGEMIA – CASE REPORT
Date Issued
2015-05
Author(s)
Abstract
Adult T cell leukemia/lymphoma (ATLL) is a rare
and often aggressive T - lymphoproliferative disorder,
etiologically linked with human T cell lymphotropic
virus type-1 (HTLV-1). HTLV-1 is endemic in Japan,
Caribbean and Africa, although sporadic cases have
been reported elsewhere in the world. ATLL affects
almost exclusively adults. There is no gender prevalence.
Depending on the disease manifestations, ATLL is classified
into several forms: acute, chronic or smoldering.
Treatment of ATLL remains a challenge for the clinicians
Patients with ATLL are immunocompromised and develop
opportunistic infections that complicate the disease
course and make its management even more difficult.
Infection with Saprochaete capitata has been reported in
patients with hematological malignancies, especially in
acute leukaemia. But, so far, infection with Saprochaete
capitata in the ATLL patients has not been reported.
We report a case of a 54 year old woman presented at the
University Clinic of Hematology in Skopje, Macedonia,
in July 2014, with intensive itching, coughing, dyspnea
and skin tumorous formations. Physical examination
revealed neither peripheral adenopathy nor organomegaly.
Diagnosis was made upon several investigations.
Beside the presence of skin lesions she had elevated
white blood cells (55,9 X 109 /L) with atypical lymphomonocytoid
cells. The bone marrow (BM) smear showed
80-90% lymphoid infiltration. The histopathological finding
was - Malignant lymphoma. PCR of BM aspirate
showed dominant monoclonal population of T lymphocytes.
Immuno-phenotyping of bone marrow cells showed
positivity for CD3, CD2, CD4, CD5, CD7, CD10, CD25,
CD38 and negative FCM7, CD79b and CD22, confirming
ATLL. Treatment started with CHOP protocol due to
acute renal failure. In the course of the disease she complained
she couldn’t walk. MRI of the back bone revealed
vertebral sclerosis with spinal stenosis L4-L5. After 3
cycles, treatment continued with Hyper-C-VAD regimen.
After the first cycle, she became neutropenic and febrile. Microbiological finding was Saprochaete capitata. Despite
treatment, she succumbed to her illness five days from
the beginning of the febrile episode and six months from
the presentation due to Saprochaete capitata fungemia.
Keywords: Adult T cell leukemia/lymphoma, Saprochaete
capitata
and often aggressive T - lymphoproliferative disorder,
etiologically linked with human T cell lymphotropic
virus type-1 (HTLV-1). HTLV-1 is endemic in Japan,
Caribbean and Africa, although sporadic cases have
been reported elsewhere in the world. ATLL affects
almost exclusively adults. There is no gender prevalence.
Depending on the disease manifestations, ATLL is classified
into several forms: acute, chronic or smoldering.
Treatment of ATLL remains a challenge for the clinicians
Patients with ATLL are immunocompromised and develop
opportunistic infections that complicate the disease
course and make its management even more difficult.
Infection with Saprochaete capitata has been reported in
patients with hematological malignancies, especially in
acute leukaemia. But, so far, infection with Saprochaete
capitata in the ATLL patients has not been reported.
We report a case of a 54 year old woman presented at the
University Clinic of Hematology in Skopje, Macedonia,
in July 2014, with intensive itching, coughing, dyspnea
and skin tumorous formations. Physical examination
revealed neither peripheral adenopathy nor organomegaly.
Diagnosis was made upon several investigations.
Beside the presence of skin lesions she had elevated
white blood cells (55,9 X 109 /L) with atypical lymphomonocytoid
cells. The bone marrow (BM) smear showed
80-90% lymphoid infiltration. The histopathological finding
was - Malignant lymphoma. PCR of BM aspirate
showed dominant monoclonal population of T lymphocytes.
Immuno-phenotyping of bone marrow cells showed
positivity for CD3, CD2, CD4, CD5, CD7, CD10, CD25,
CD38 and negative FCM7, CD79b and CD22, confirming
ATLL. Treatment started with CHOP protocol due to
acute renal failure. In the course of the disease she complained
she couldn’t walk. MRI of the back bone revealed
vertebral sclerosis with spinal stenosis L4-L5. After 3
cycles, treatment continued with Hyper-C-VAD regimen.
After the first cycle, she became neutropenic and febrile. Microbiological finding was Saprochaete capitata. Despite
treatment, she succumbed to her illness five days from
the beginning of the febrile episode and six months from
the presentation due to Saprochaete capitata fungemia.
Keywords: Adult T cell leukemia/lymphoma, Saprochaete
capitata
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