Ohata J, Matsuoka M, Yamashita T, Tojo A, Tani K, Asano S
Department of Hematology, University of Tokyo, Japan.
Int J Hematol. 1999 Feb;69(2):92-5.
We present a rare case of adult T cell leukemia (ATL) in which leukemic T cells simultaneously expressed CD4 and CD8 surface antigens and refractory cytomegalovirus (CMV)-induced gastroenterocolitis preceded its clinical onset. A 40-year-old male was admitted to our hospital with abdominal pain and bloody stool. Biopsy specimens of the gastric and rectal mucosa indicated CMV-induced gastroenterocolitis. The patient also proved to be seropositive for human T lymphotropic virus type I (HTLV-I). While being administered gancyclovir for CMV infection, he presented hepatomegaly and systemic lymphadenopathy. Monoclonal expansion of lymphoid cells integrated with HTLV-I genome was observed. He underwent a LSG15 regimen and hepatomegaly and lymphadenopathy improved markedly. Gastroenterocolitis also improved, but the symptoms did not disappear completely. CMV-induced diseases are prevalent among immunosuppressed patients. Although there was no evidence that this patient had ATL on admission, it is likely that he was severely immunodeficient. CMV can easily infect damaged mucosa. ATL cells often infiltrate gastrointestinal mucosa and may have triggered CMV gastroenterocolitis in this case.
我们报告一例罕见的成人T细胞白血病（ATL），其白血病T细胞同时表达CD4和CD8表面抗原，且难治性巨细胞病毒（CMV）诱导的胃肠结肠炎先于其临床发病。一名40岁男性因腹痛和便血入院。胃和直肠黏膜活检标本显示为CMV诱导的胃肠结肠炎。该患者还被证明人类嗜T淋巴细胞病毒I型（HTLV-I）血清学阳性。在接受更昔洛韦治疗CMV感染期间，他出现肝肿大和全身淋巴结病。观察到与HTLV-I基因组整合的淋巴细胞单克隆扩增。他接受了LSG15方案治疗，肝肿大和淋巴结病明显改善。胃肠结肠炎也有所改善，但症状并未完全消失。CMV诱导的疾病在免疫抑制患者中很常见。虽然入院时没有证据表明该患者患有ATL，但他很可能存在严重免疫缺陷。CMV很容易感染受损黏膜。ATL细胞常浸润胃肠道黏膜，在本例中可能引发了CMV胃肠结肠炎。
