以肝内 T 细胞浸润为首发表现的成人 T 细胞白血病/淋巴瘤致急性肝损伤

Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan.

Division of Hematology and malignancy, Department of Internal Medicine, Iwate Medical University, Japan.

Intern Med. 2021;60(15):2431-2436. doi: 10.2169/internalmedicine.6793-20. Epub 2021 Aug 1.

Acute liver injury (ALI) has been rarely reported as a clinical finding of adult T-cell leukemia/lymphoma (ATLL). A 74-year-old Japanese female patient who was histologically diagnosed as having autoimmune hepatitis (AIH) one year earlier, showed elevations in her aminotransferase and total bilirubin levels, and this was considered to be an exacerbation of AIH. Liver biopsy revealed interface hepatitis. Because atypical lymphocytes and human T-cell leukemia virus 1 immunoglobulin G antibody were positive, the patient was diagnosed to have ATLL. The biopsy revealed CD4+ and CD8+, but not CD20+ lymphocytes. Thus, the ALI in the patient was due to T-cell infiltration into the liver, and not due to an exacerbation of AIH.

急性肝损伤（ALI）作为成人 T 细胞白血病/淋巴瘤（ATLL）的临床表现很少见。一名 74 岁的日本女性患者，一年前被组织学诊断为自身免疫性肝炎（AIH），其氨基转移酶和总胆红素水平升高，被认为是 AIH 的恶化。肝活检显示界面肝炎。由于存在非典型淋巴细胞和人类 T 细胞白血病病毒 1 免疫球蛋白 G 抗体阳性，该患者被诊断为 ATLL。活检显示 CD4+和 CD8+，但无 CD20+淋巴细胞。因此，该患者的 ALI 是由于 T 细胞浸润肝脏所致，而不是 AIH 的恶化。