Smoldering adult T-cell leukemia complicated with pneumocystis pneumonia: A case report
Adult T-cell leukemia (ATL) is a tumor of CD4-positive T cells that accompanies an infection by human T-cell lymphotropic virus (HTLV-I). ATL is classified into four types—acute, lymphomatous, chronic, and smoldering. Opportunistic infections are known to occur in patients with acute or lymphomatous...
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2021-01-01
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doaj-c74d3cd12a87450e8963cd24935feeb82021-07-31T04:39:21ZengElsevierRespiratory Medicine Case Reports2213-00712021-01-0133101404Smoldering adult T-cell leukemia complicated with pneumocystis pneumonia: A case reportKazuma Kawamoto0Masahiro Yamasaki1Masaya Taniwaki2Mituhiro Itagaki3Wakako Daido4Yu Matsumoto5Naoko Matsumoto6Yusuke Izumi7Masaya Otohara8Nobuyuki Ohashi9Noboru Hattori10Department of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan; Corresponding author. Department of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima 730-8619, Japan.Department of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Minami-ku, Hiroshima, JapanDepartment of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Minami-ku, Hiroshima, JapanDepartment of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanDepartment of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, JapanOhashi Clinic, Naka-ku, Hiroshima, JapanDepartment of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Minami-ku, Hiroshima, JapanAdult T-cell leukemia (ATL) is a tumor of CD4-positive T cells that accompanies an infection by human T-cell lymphotropic virus (HTLV-I). ATL is classified into four types—acute, lymphomatous, chronic, and smoldering. Opportunistic infections are known to occur in patients with acute or lymphomatous type ATL; however, whether patients with chronic or smoldering ATL also have a high risk of opportunistic infections is not yet known. Herein, we report a case of pneumocystis pneumonia in a patient with smoldering ATL. He was a 64-year-old man with primary complaints of cough and dyspnea on exertion. A chest radiograph showed infiltration shadows in the left lung field. He was prescribed antibiotics for pneumonia; however, his symptoms worsened, and he developed hypoxemia. White-blood cell count was 13000/μL, and 7% of atypical lymphocytes were found in the smears of peripheral blood cells. His serum β-D glucan concentration was increased to 85.9 pg/mL, and his serum tested positive for anti–HTLV-1 antibody. Chest-computed tomography revealed diffuse ground-glass opacities in the bilateral lung fields. Pneumocystis-polymerase chain reaction performed on bronchoalveolar lavage fluid confirmed pneumocystis, but atypical lymphocytes were not detected via transbronchial lung biopsy. Therefore, he was diagnosed with pneumocystis pneumonia associated with smoldering ATL. Sulfamethoxazole-trimethoprim and corticosteroid therapies were administered to treat the pneumocystis pneumonia, and his symptoms and lung shadows improved rapidly. Thus, opportunistic infections, including pneumocystis pneumonia, may be caused by smoldering ATL. In the case of atypical lymphocyte detection in peripheral-blood smears, clinicians should consider the possibility of ATL.http://www.sciencedirect.com/science/article/pii/S2213007121000666Smoldering adult T-cell leukemiaHuman T-cell lymphotropic virusPneumocystis pneumoniaOpportunistic infectionAtypical lymphocyte |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kazuma Kawamoto Masahiro Yamasaki Masaya Taniwaki Mituhiro Itagaki Wakako Daido Yu Matsumoto Naoko Matsumoto Yusuke Izumi Masaya Otohara Nobuyuki Ohashi Noboru Hattori |
spellingShingle |
Kazuma Kawamoto Masahiro Yamasaki Masaya Taniwaki Mituhiro Itagaki Wakako Daido Yu Matsumoto Naoko Matsumoto Yusuke Izumi Masaya Otohara Nobuyuki Ohashi Noboru Hattori Smoldering adult T-cell leukemia complicated with pneumocystis pneumonia: A case report Respiratory Medicine Case Reports Smoldering adult T-cell leukemia Human T-cell lymphotropic virus Pneumocystis pneumonia Opportunistic infection Atypical lymphocyte |
author_facet |
Kazuma Kawamoto Masahiro Yamasaki Masaya Taniwaki Mituhiro Itagaki Wakako Daido Yu Matsumoto Naoko Matsumoto Yusuke Izumi Masaya Otohara Nobuyuki Ohashi Noboru Hattori |
author_sort |
Kazuma Kawamoto |
title |
Smoldering adult T-cell leukemia complicated with pneumocystis pneumonia: A case report |
title_short |
Smoldering adult T-cell leukemia complicated with pneumocystis pneumonia: A case report |
title_full |
Smoldering adult T-cell leukemia complicated with pneumocystis pneumonia: A case report |
title_fullStr |
Smoldering adult T-cell leukemia complicated with pneumocystis pneumonia: A case report |
title_full_unstemmed |
Smoldering adult T-cell leukemia complicated with pneumocystis pneumonia: A case report |
title_sort |
smoldering adult t-cell leukemia complicated with pneumocystis pneumonia: a case report |
publisher |
Elsevier |
series |
Respiratory Medicine Case Reports |
issn |
2213-0071 |
publishDate |
2021-01-01 |
description |
Adult T-cell leukemia (ATL) is a tumor of CD4-positive T cells that accompanies an infection by human T-cell lymphotropic virus (HTLV-I). ATL is classified into four types—acute, lymphomatous, chronic, and smoldering. Opportunistic infections are known to occur in patients with acute or lymphomatous type ATL; however, whether patients with chronic or smoldering ATL also have a high risk of opportunistic infections is not yet known. Herein, we report a case of pneumocystis pneumonia in a patient with smoldering ATL. He was a 64-year-old man with primary complaints of cough and dyspnea on exertion. A chest radiograph showed infiltration shadows in the left lung field. He was prescribed antibiotics for pneumonia; however, his symptoms worsened, and he developed hypoxemia. White-blood cell count was 13000/μL, and 7% of atypical lymphocytes were found in the smears of peripheral blood cells. His serum β-D glucan concentration was increased to 85.9 pg/mL, and his serum tested positive for anti–HTLV-1 antibody. Chest-computed tomography revealed diffuse ground-glass opacities in the bilateral lung fields. Pneumocystis-polymerase chain reaction performed on bronchoalveolar lavage fluid confirmed pneumocystis, but atypical lymphocytes were not detected via transbronchial lung biopsy. Therefore, he was diagnosed with pneumocystis pneumonia associated with smoldering ATL. Sulfamethoxazole-trimethoprim and corticosteroid therapies were administered to treat the pneumocystis pneumonia, and his symptoms and lung shadows improved rapidly. Thus, opportunistic infections, including pneumocystis pneumonia, may be caused by smoldering ATL. In the case of atypical lymphocyte detection in peripheral-blood smears, clinicians should consider the possibility of ATL. |
topic |
Smoldering adult T-cell leukemia Human T-cell lymphotropic virus Pneumocystis pneumonia Opportunistic infection Atypical lymphocyte |
url |
http://www.sciencedirect.com/science/article/pii/S2213007121000666 |
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