A case of human T lymphotropic virus type I-associated synovial swelling.
BACKGROUND
Human T lymphotropic virus type 1 (HTLV-I) is associated with T-cell activation, proliferation, and leukemogenesis. HTLV-I is the causative agent of adult T cell leukemia/lymphoma and is associated with myelopathy/tropical spastic paraparesis, uveitis, polymyositis, synovitis, thyroiditis, and bronchoalveolar pneumonia. Since T-cell abnormalities are present in those infected with HTLV-I, the clinical problems might result from abnormal immune function or from direct leukemic or lymphomatous cell infiltration of tissues in the body. Distinguishing between these potential causes might be difficult in patients with joint involvement since the clinical findings can be similar. Consequently, obtaining synovial tissue for analyses is likely to be helpful in determining which process is causing the clinical symptoms.


METHODS
Physical examination, comprehensive metabolic panel, complete blood counts, urinalysis, serological testing for rheumatoid factor, antinuclear antibodies, hepatitis, and cytomegalovirus; western blot for HTLV-I/II, lymphocyte phenotyping of peripheral blood, polymerase chain reaction, plain radiographic imaging, CT, MRI skin biopsy with immunohistochemical analysis, lymph node biopsy with immunohistochemical analysis, lymphocyte phenotyping of synovial fluid, synovial tissue biopsy with immunohistochemical analysis of synovial tissue, and synovial tissue culture.


METHODS
HTLV-I infected synovial cells in conjunction with leukemic/lymphomatous infiltration of synovial tissue.


RESULTS
Chemotherapy protocol using alemtuzumab.
Dennis
Gregory
G
Clinical Development for Inflammatory Diseases at MedImmune, Inc., MD, USA. dennisg@medimmune.com
Chitkara
Puja
P
D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D013585:Synovitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014955:Wrist Joint / Q000473:pathology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000970:Antineoplastic Agents; D000074323:Alemtuzumab