Gonçalves D U, Guedes A C, Carneiro-Proietti A B, Lambertucci J R
Departments of Internal Medicine,Dermatology, Ophthalmology, Preventive and Social Medicine, Federal University of Minas Gerais.
Braz J Infect Dis. 2000 Apr;4(2):100-2.
When present for a first time blood donation, a 28-year-old Brazilian white female reported a pruritic eczema of the scalp and retroauricular areas since childhood that had been frequently infected. Her mother had been diagnosed as having HTLV-I-associated myelopathy (HAM), and the patient was found to be a human T-lymphotropic virus type-I (HTLV-I) carrier. The patient had been breast-fed for 6 months. The patient had a complete examination, and a biopsy was taken from eczema in the retroauricular area. The biopsy indicated chronic lymphohistiocytic dermatitis with no abnormal lymphocytes. Eleven months later, the patient had an infiltration in the skin of the retroauricular area and a new biopsy revealed atypical lymphocytes. Nested polymerase chain reaction (PCR) was positive for HTLV-I and immunohistochemistry of the tissue at this time confirmed adult T-cell leukemia/lymphoma (ATLL). Retrospective immunohistochemistry showed that the first fragment submitted from the biopsy 11 months before was also compatible with the diagnosis of ATLL. This case fulfilled all major criteria for diagnosis of HTLV-I-associated infective dermatitis (HTLV-I-ID). We postulate that the patient had indolent ATLL associated with HTLV-I infective dermatitis since childhood. We recommend that tissue immunohistochemistry analysis be done in any patient with HTLV-associated infective dermatitis.
一名28岁的巴西白人女性首次献血时，自述自幼头皮和耳后区域患有瘙痒性湿疹，且经常感染。她的母亲被诊断患有HTLV-I相关脊髓病（HAM），该患者被发现是人T淋巴细胞病毒I型（HTLV-I）携带者。患者曾接受6个月的母乳喂养。患者接受了全面检查，并从耳后区域的湿疹处取了活检。活检显示为慢性淋巴细胞组织细胞性皮炎，无异常淋巴细胞。11个月后，患者耳后区域皮肤出现浸润，再次活检发现非典型淋巴细胞。巢式聚合酶链反应（PCR）检测HTLV-I呈阳性，此时组织免疫组化确诊为成人T细胞白血病/淋巴瘤（ATLL）。回顾性免疫组化显示，11个月前首次活检送检的切片也符合ATLL的诊断。该病例符合HTLV-I相关感染性皮炎（HTLV-I-ID）诊断的所有主要标准。我们推测该患者自幼患有与HTLV-I感染性皮炎相关的惰性ATLL。我们建议对任何患有HTLV相关感染性皮炎的患者进行组织免疫组化分析。
