title: HTLV-1-associated adult T cell leukemia lymphoma presenting as granulomatous pneumocystis jiroveci pneumonia (PJP) and hypercalcemia.
abstract: 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.
authors.affiliation: Department of Medicine, Mount Sinai Services, Queens Hospital Center, Jamaica, NY 11432, USA.
authors.forename: Sabiha
authors.initials: S
authors.lastname: Shahnaz
authors.forename: David
authors.initials: D
authors.lastname: Reich
authors.forename: Diana
authors.initials: D
authors.lastname: Arévalo-Valencia
authors.forename: Slavka
authors.initials: S
authors.lastname: Kucinska
authors.forename: Joanna
authors.initials: J
authors.lastname: Tulczynska
authors.forename: Jean
authors.initials: J
authors.lastname: Fleischman
mesh_terms: 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*