title: Multifaceted adult T-cell leukemia/lymphoma in India: a case series.
abstract: BACKGROUND
  Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India.
  
  
  OBJECTIVE
  The objective was to describe skin manifestations in various types of ATL.
  
  
  METHODS
  Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases.
  
  
  RESULTS
  Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period.
  
  
  CONCLUSIONS
  ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.
authors: Department of Dermatology, Government Medical College, Calicut, Kerala, India.
authors: Anza
authors: A
authors: Khader
authors: Department of Medicine, Government Medical College, Calicut, Kerala, India.
authors: Mohamed
authors: M
authors: Shaan
authors: Department of Pathology, Government Medical College, Calicut, Kerala, India.
authors: Sunitha
authors: S
authors: Balakrishnan
authors: Department of Dermatology, Government Medical College, Calicut, Kerala, India.
authors: Betsy
authors: B
authors: Ambooken
authors: Department of Dermatology, Government Medical College, Calicut, Kerala, India.
authors: Kunnummel
authors: K
authors: Muhammed
authors: Department of Dermatology, Government Medical College, Calicut, Kerala, India.
authors: Uma
authors: U
authors: Rajan
keywords: Adult T-cell leukemia/lymphoma; India; skin lesions
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