HTLV-1 Associated Adult T cell Leukemia-Lymphoma (ATLL) Presenting as Cutaneous Lymphoma and Hypercalcemia: A Case Report and Review of the Literature

Abstract

Human T-cell Lymphotropic virus-1 (HTLV-1) belongs to oncovirus family of retroviruses, which unlike HIV virus remains asymptomatic in majority of patients throughout their life time. The latent period of infection varies geographically, ranging from 60 years in Japan to less than 40 years in the Caribbean. The highest incidence and prevalence is seen in Japan (1%-20%), followed by the Caribbean and African countries. An estimated 20 million of population is infected worldwide. HTLV-1 is associated with various diseases such as malignancies, inflammations, opportunistic infections, rheumatic and autoimmune conditions. Hypercalcemia can be due to increased levels of parathyroid hormone related peptide (PTHrP), vitamin D levels, tumor necrosis factor (TNF), transforming growth factor-Beta (TGF-I²) and/or interleukins. We present a case of 39 year old male with HTLV-1 associated Adult T cell leukemia-lymphoma (ATLL) presenting as cutaneous lymphoma and hypercalcemia which responded to Zoledronate. The treatment strategy differs from case to case with interferons/chemotherapies for malignancies to antiretroviral medications. However, hypercalcemia management dominates the clinical course.