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Laher AE, Ebrahim O. HTLV-1, ATLL, severe hypercalcaemia and HIV-1 co-infection: an overview. Pan Afr Med J 2018; 30:61. [PMID: 30344845 PMCID: PMC6191272 DOI: 10.11604/pamj.2018.30.61.13238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 04/30/2018] [Indexed: 11/11/2022] Open
Abstract
HIV and HTLV (Human T-ymphotropic Virus) are the only known retroviruses responsible for causing infection in humans. HTLV-1 and HIV-1 are frequent co-pathogens, however, despite its potential for accelerated progression of HIV disease and the risk of developing adult T-cell lymphoma/leukemia (ATLL), HTLV-1 is seldom considered for investigation in the HIV-1 positive individual. Severe/refractory hypercalcaemia, unresponsive to conventional calcium lowering therapy may complicate up to 70% of cases of ATLL. In addition, HTLV-1 and ATLL have both been associated with a rise in dysfunctional CD4 lymphocytes, thereby conveying a false sense of immune competence in the HIV-1 infected individual.
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Affiliation(s)
- Abdullah Ebrahim Laher
- Department of Emergency Medicine and Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, 5 Jubilee Road, Parktown, Johannesburg, 2193, South Africa
| | - Osman Ebrahim
- Department of Internal Medicine and HIV clinic, Life Brenthurst Hospital, Johannesburg, South Africa
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Laher AE, Motara F, Moolla M, Ebrahim O. HTLV-1, ATLL, refractory hypercalcaemia and HIV-1 co-infection. Oxf Med Case Reports 2018; 2018:omx081. [PMID: 29744126 PMCID: PMC5934651 DOI: 10.1093/omcr/omx081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/10/2017] [Accepted: 10/25/2017] [Indexed: 11/18/2022] Open
Abstract
Adult T-cell lymphoma/leukemia (ATLL) is a rare tumour of T-lymphocytes that is associated with human T-lymphotrophic virus type 1 (HTLV-1) infection as well as severe/refractory hypercalcaemia. Human immunodefficiency virus type 1 (HIV-1) infected individuals are at increased risk of acquiring co-infection with HTLV-1. We present the case of a 37 -year -old HIV-1 positive and antiretroviral therapy naive woman who was admitted to the ICU with delirium, a generalised maculopapular rash, severe hypercalcaemia of 4.48 mmol/L (normal < 2.7 mmol/L) and a positive HTLV-1 serology. The diagnosis of ATLL was confirmed on biopsy. Her hypercalcaemic state proved refractory to conventional therapy, but was rapidly corrected with a modified haemodialysis technique using a dialysate with a low low-calcium concentration.
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Affiliation(s)
- Abdullah E Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Feroza Motara
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Muhammed Moolla
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Osman Ebrahim
- Department of Internal Medicine and HIV Clinic, Life Brenthurst Hospital, Johannesburg, South Africa
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Kunnathuparambil SG, Payangappadom PK, Yerol PK, Madhavan M, Sreesh S, Narayanan P, Devdas K, Ramakrishanan Kattoor V. Hypercalcemic crisis due to adult T cell leukemia: a rare cause of paralytic ileus. Ann Gastroenterol 2012; 25:170-172. [PMID: 24714244 PMCID: PMC3959384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/11/2012] [Indexed: 11/18/2022] Open
Abstract
Adult T cell leukemia- lymphoma is a rare aggressive malignancy of the peripheral T lymphocytes, caused by human T cell lymphotropic virus -1 (HTLV-1) infection. Hypercalcemia occurs in about 70% of patients with acute adult T cell leukemia. However, there are very few case reports of adult T cell leukemia presenting as a hypercalcemic crisis. We report a case of a 54-year-old male who presented with abdominal pain, constipation and altered sensorium. On examination he had generalized lymphadenopathy, hepatosplenomegaly and paralytic ileus. Investigation revealed hypercalcemic crisis with low parathormone (PTH) levels. Peripheral smear and bone marrow aspirate were consistent with adult T cell leukemia. HTLV-1 serology was positive. Despite the corrective measures for hypercalcemia and chemotherapy, he succumbed to the illness in a week.
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Affiliation(s)
- Sojan George Kunnathuparambil
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India,
Correspondence to: Dr Sojan George Kunnathuparambil, Senior Resident, Department of Medical Gastroenterology, SSB – 3, super specialty block 3rd floor, Govt. Medical College, Thiruvananthapuram 695 011, India, Tel: +01 94000 73067, e-mail:
| | | | - Praveen Kumar Yerol
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Mukunda Madhavan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sreejaya Sreesh
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Premaletha Narayanan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Krishnadas Devdas
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
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Raza S, Naik S, Kancharla VP, Tafera F, Kalavar MR. Dual-Positive (CD4+/CD8+) Acute Adult T-Cell Leukemia/Lymphoma Associated with Complex Karyotype and Refractory Hypercalcemia: Case Report and Literature Review. Case Rep Oncol 2010; 3:489-94. [PMID: 21611103 PMCID: PMC3100272 DOI: 10.1159/000323163] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe a rare case of adult T-cell leukemia characterized by an expansion of CD4+ CD8+ double-positive lymphocytes associated with human T-lymphotropic virus type 1 (HTLV-1) and a complex karyotype in a 43-year-old Caribbean male who was initially admitted to our hospital with significant lethargy, visual disturbances, dysphagia, right facial palsy and numbness in both feet for 3 days. He was found to have severe hypercalcemia (15.6 mg/dl). Peripheral blood smear showed multilobulated clover-shaped nuclei. Bone marrow and CSF flow cytometries revealed abnormal monoclonal expansion of T cells positive for CD4, CD5, CD8 and CD25 but negative for CD7, CD20, CD56, CD68 and terminal deoxynucleotidyl transferase. The polymerase chain reaction analysis showed a distinct band of the T-cell receptor γ gene, revealing T-cell clonal integration of the proviral DNA of HTLV-1, thus confirming the diagnosis of acute adult T-cell leukemia/lymphoma. Cytogenetic study revealed a male karyotype with monosomy 12, unbalanced translocation 5q and 13q and additional material on 5q, 7q, 14q and 17q. The patient underwent prednisone (EPOCH) chemotherapy followed by autologous transplantation with BEAM regimen. Although patients with a rare mixed CD4+ CD8+ immunophenotype usually present with an aggressive clinical course and have a poor prognosis, our patient was able to survive for 2.5 years.
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Affiliation(s)
- Shahzad Raza
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, N.Y., USA
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Lloréns C, Futami R, Bezemer D, Moya A. The Gypsy Database (GyDB) of mobile genetic elements. Nucleic Acids Res 2008; 36:D38-46. [PMID: 17895280 PMCID: PMC2238898 DOI: 10.1093/nar/gkm697] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 08/19/2007] [Accepted: 08/22/2007] [Indexed: 02/07/2023] Open
Abstract
In this article, we introduce the Gypsy Database (GyDB) of mobile genetic elements, an in-progress database devoted to the non-redundant analysis and evolutionary-based classification of mobile genetic elements. In this first version, we contemplate eukaryotic Ty3/Gypsy and Retroviridae long terminal repeats (LTR) retroelements. Phylogenetic analyses based on the gag-pro-pol internal region commonly presented by these two groups strongly support a certain number of previously described Ty3/Gypsy lineages originally reported from reverse-transcriptase (RT) analyses. Vertebrate retroviruses (Retroviridae) are also constituted in several monophyletic groups consistent with genera proposed by the ICTV nomenclature, as well as with the current tendency to classify both endogenous and exogenous retroviruses by three major classes (I, II and III). Our inference indicates that all protein domains codified by the gag-pro-pol internal region of these two groups agree in a collective presentation of a particular evolutionary history, which may be used as a main criterion to differentiate their molecular diversity in a comprehensive collection of phylogenies and non-redundant molecular profiles useful in the identification of new Ty3/Gypsy and Retroviridae species. The GyDB project is available at http://gydb.uv.es.
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Affiliation(s)
- C. Lloréns
- Biotech Vana, Valencia, Institut Cavanilles de Biodiversitat i Biología Evolutiva Universitat de València, Spain, HIV Monitoring Foundation, Amsterdam, The Netherlands and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - R. Futami
- Biotech Vana, Valencia, Institut Cavanilles de Biodiversitat i Biología Evolutiva Universitat de València, Spain, HIV Monitoring Foundation, Amsterdam, The Netherlands and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - D. Bezemer
- Biotech Vana, Valencia, Institut Cavanilles de Biodiversitat i Biología Evolutiva Universitat de València, Spain, HIV Monitoring Foundation, Amsterdam, The Netherlands and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - A. Moya
- Biotech Vana, Valencia, Institut Cavanilles de Biodiversitat i Biología Evolutiva Universitat de València, Spain, HIV Monitoring Foundation, Amsterdam, The Netherlands and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Shahnaz S, Reich D, Arévalo-Valencia D, Kucinska S, Tulczynska J, Fleischman J. HTLV-1-associated adult T cell leukemia lymphoma presenting as granulomatous pneumocystis jiroveci pneumonia (PJP) and hypercalcemia. J Gen Intern Med 2007; 22:420-3. [PMID: 17356979 PMCID: PMC1824742 DOI: 10.1007/s11606-006-0047-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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. CASE REPORT 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. CONCLUSION 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.
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Affiliation(s)
- Sabiha Shahnaz
- Department of Medicine, Mount Sinai Services, Queens Hospital Center, 82-68 164th Street, Jamaica, NY 11432 USA
- Mount Sinai School of Medicine, New York, NY USA
| | - David Reich
- Department of Medicine, Mount Sinai Services, Queens Hospital Center, 82-68 164th Street, Jamaica, NY 11432 USA
- Mount Sinai School of Medicine, New York, NY USA
| | - Diana Arévalo-Valencia
- Department of Medicine, Mount Sinai Services, Queens Hospital Center, 82-68 164th Street, Jamaica, NY 11432 USA
- Mount Sinai School of Medicine, New York, NY USA
| | - Slavka Kucinska
- Department of Medicine, Mount Sinai Services, Queens Hospital Center, 82-68 164th Street, Jamaica, NY 11432 USA
- Mount Sinai School of Medicine, New York, NY USA
| | - Joanna Tulczynska
- Department of Medicine, Mount Sinai Services, Queens Hospital Center, 82-68 164th Street, Jamaica, NY 11432 USA
- Mount Sinai School of Medicine, New York, NY USA
| | - Jean Fleischman
- Department of Medicine, Mount Sinai Services, Queens Hospital Center, 82-68 164th Street, Jamaica, NY 11432 USA
- Mount Sinai School of Medicine, New York, NY USA
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