Shahnaz Sabiha, Reich David, Arévalo-Valencia Diana, Kucinska Slavka, Tulczynska Joanna, Fleischman Jean
Department of Medicine, Mount Sinai Services, Queens Hospital Center, Jamaica, NY 11432, USA.
J Gen Intern Med. 2007 Mar;22(3):420-3. doi: 10.1007/s11606-006-0047-6.
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.
We report the case of a 39-year-old Afro-Caribbean man with HTLV-1 infection presenting as hypercalcemia and granulomatous pneumocystis jiroveci pneumonia.
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.
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.
自首次描述人类嗜T细胞病毒1型（HTLV-1）以来，全球已检测到这种感染的聚集情况。与HIV感染不同，大多数感染HTLV-1的患者终生无症状。
我们报告了一名39岁的非洲加勒比男性感染HTLV-1的病例，其表现为高钙血症和耶氏肺孢子菌肉芽肿性肺炎。
有趣的是，高钙血症表现为甲状旁腺激素相关蛋白正常和1,25-二羟维生素D水平低，通过支气管镜检查期间进行的经支气管活检诊断出肉芽肿中存在耶氏肺孢子菌。通过骨髓和淋巴结活检，该患者被诊断为HTLV-1相关成人T细胞白血病淋巴瘤（ATLL）。
骨吸收增加，可能是细胞因子介导的，是该患者高钙血症最可能的机制。据信这是HTLV-1感染的ATLL患者中对耶氏肺孢子菌这种反应类型的首次描述。
