Adult T-Cell Leukemia/Lymphoma-Related Ocular Manifestations: Analysis of the First Large-Scale Nationwide Survey.

Koju Kamoi,Shuji Izumo,Arinobu Tojo,Kaoru Uchimaru,Isao Hamaguchi,Kyoko Ohno-Matsui,Akihiko Okayama

doi:10.3389/fmicb.2018.03240

Abstract

Adult T-cell leukemia/lymphoma (ATL) is a rare and aggressive T-cell malignancy with a high mortality rate, resulting in a lack of information among ophthalmologists. Here, we investigated the state of ophthalmic medical care for ATL and ATL-related ocular manifestations by conducting the first large-scale nationwide survey in Japan. A total of 115 facilities were surveyed, including all university hospitals in Japan that were members of the Japanese Ophthalmological Society and regional core facilities that were members of the Japanese Ocular Inflammation Society. The collected nationwide data on the state of medical care for ATL-related ocular manifestations and ATL-associated ocular findings were categorized, tallied, and analyzed. Of the 115 facilities, 69 (60%) responded. Overall, 28 facilities (43.0%) had experience in providing ophthalmic care to ATL patients. ATL-related ocular manifestations were most commonly diagnosed “based on blood tests and characteristic ophthalmic findings.” By analyzing the 48 reported cases of ATL-related ocular manifestations, common ATL-related ocular lesions were intraocular infiltration (22 cases, 45.8%) and opportunistic infections (19 cases, 39.6%). All cases of opportunistic infection were cytomegalovirus retinitis. Dry eye (3 cases, 6.3%), scleritis (2 cases, 4.2%), uveitis (1 case, 2.1%), and anemic retinopathy (1 case, 2.1%) were also seen. In conclusion, intraocular infiltration and cytomegalovirus retinitis are common among ATL patients, and ophthalmologists should keep these findings in mind in their practice.

Highlights

Human T-cell leukemia virus type 1 (HTLV-1) was the first retrovirus found to infect and cause disease in humans (Hinuma et al, 1981)
Ophthalmic care is required for HTLV-1 uveitis (HU) and adult T-cell leukemia/ lymphoma (ATL)-related ocular manifestations (Kamoi and Mochizuki, 2012a), but ATL-related ophthalmic manifestations remain relatively obscure among ophthalmologists (Kamoi and Mochizuki, 2012a)
Responses were received from facilities throughout Japan, with those in the Kanto region accounting for 39.1% of overall respondents and those in the high-prevalence Kyushu region accounting for 13.0% (Table 2)

Summary

Introduction

Human T-cell leukemia virus type 1 (HTLV-1) was the first retrovirus found to infect and cause disease in humans (Hinuma et al, 1981). The routes of transmission are primarily through sexual contact to adults, and through breast milk to infants (Iwanaga et al, 2009). Such infections are prevalent in Melanesia, the Caribbean Islands, Central and South America, and Central Africa, as well as areas such as Kyushu and Okinawa in Southwestern Japan (Watanabe, 2011). HTLV-1 causes diseases such as adult T-cell leukemia/ lymphoma (ATL) (Yoshida et al, 1984), HTLV-1-associated myelopathy (HAM) (Osame et al, 1986), and HTLV-1 uveitis (HU) (Mochizuki et al, 1992a,b; Kamoi and Mochizuki, 2012b). Ophthalmic care is required for HU and ATL-related ocular manifestations (Kamoi and Mochizuki, 2012a), but ATL-related ophthalmic manifestations remain relatively obscure among ophthalmologists (Kamoi and Mochizuki, 2012a)

Methods

Results

Conclusion