HTLV-1-associated adult T cell leukemia lymphoma presenting as granulomatous pneumocystis jiroveci pneumonia (PJP) and hypercalcemia.
BACKGROUND
Since the initial description of human T cell lymphotropic virus (HTLV-1), clusters of this infection have been detected globally. Unlike HIV infection, most patients infected with HTLV-1 remain asymptomatic throughout their lifetime.


METHODS
We report the case of a 39-year-old Afro-Caribbean man with HTLV-1 infection presenting as hypercalcemia and granulomatous pneumocystis jiroveci pneumonia.


RESULTS
Interestingly, the hypercalcemia presented with normal parathyroid hormone-related protein and low 1,25 dihydroxyvitamin D levels, and the presence of pneumocystis jiroveci in the granulomas was diagnosed with transbronchial biopsy taken during bronchoscopy. HTLV-1-associated adult T cell leukemia lymphoma (ATLL) was diagnosed in this patient by bone marrow and lymph node biopsy.


CONCLUSIONS
Increased bone resorption, likely cytokine-mediated, is the most likely mechanism of hypercalcemia in this patient. This is believed to be the first description of this type of reaction to pneumocystis jiroveci in a HTLV-1-infected ATLL patient.
Shahnaz
Sabiha
S
Department of Medicine, Mount Sinai Services, Queens Hospital Center, Jamaica, NY 11432, USA.
Reich
David
D
Arévalo-Valencia
Diana
D
Kucinska
Slavka
S
Tulczynska
Joanna
J
Fleischman
Jean
J
D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D015490:HTLV-I Infections / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000175:diagnosis*; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000097:blood / Q000175:diagnosis*; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000097:blood / Q000175:diagnosis*