Atypical presentation of adult T-cell leukaemia/lymphoma due to HTLV-1: prurigo nodularis lasting twelve years followed by an acute micropapular eruption.
Prurigo nodularis is a pruritic dermatosis of unknown origin. Human T-cell lymphotropic virus type 1 (HTLV-1) causes adult T-cell leukaemia/lymphoma. HTLV-1 is not considered to be a cause of prurigo nodularis. A 52-year-old black man, from the French West Indies, who had had prurigo nodularis for 12 years, presented with a distinct micropapular eruption with the typical pathological picture of epidermotropic T-cell lymphoma. Based on HTLV-1-positive serology and monoclonal integration of HTLV-1 we diagnosed smouldering adult T-cell leukaemia/lymphoma. Re-examination of previous skin biopsies revealed that the disease had been evolving for 12 years. Treatment with alpha-interferon, 3 x 106 units three times a week, associated with zidovudine, 1 g daily, resulted in complete remission within 4 months. When investigating a prurigo nodularis, we therefore recommend: (i) performing HTLV-1 serology if the patient comes from an endemic area; (ii) if positive, performing CD25 staining and looking for a HTLV-1 clonal integration; and (iii) if positive, using a treatment targeting HTLV-1.
Service de Dermatologie, Hôpital Saint-Louis, FR-75010 Paris, France. arnaudduval@netcourrier.com
Arnaud
A
Duval
Jacqueline
J
Rivet
Isabelle
I
Moulonguet
Olivier
O
Cassar
Félix
F
Agbalika
Daniel
D
Wallach
Antoine
A
Gessain
Antoine
A
Petit
D000754:Anemia, Refractory, with Excess of Blasts / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000821:virology; D015368:Human T-lymphotropic virus 1 / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D053645:Interleukin-2 Receptor alpha Subunit / Q000032:analysis; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011536:Prurigo / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000821:virology*; D011994:Recombinant Proteins; D012867:Skin / Q000276:immunology / Q000473:pathology / Q000821:virology*; D013997:Time Factors; D016896:Treatment Outcome; D015215:Zidovudine / Q000627:therapeutic use
D000970:Antineoplastic Agents; D000998:Antiviral Agents; C508017:IL2RA protein, human; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D053645:Interleukin-2 Receptor alpha Subunit; D011994:Recombinant Proteins; D015215:Zidovudine